bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Influencing the Hospital Admission Decision of Low-Risk Patients with Community Acquired Pneumonia: Evaluating the Usefulness of a Prediction Rule
Authors: Chan Ssw , Cheung Wl , Cocks Ra 
Published: December 2017

Introduction The Pneumonia Patient Outcomes Research Team (PORT) derived and validated a Prediction Rule to identify low-risk patients with community-acquired pneumonia (CAP).1 This prediction rule was implemented in the Accident & Emergency (A&E) Department of Prince of Wales Hospital to help select patients suitable for outpatient treatment. Materials & Methods A retrospective study of all cases of CAP admitted from A&E, age above 14, over a six-month period (the period of implementation of the Prediction Rule) was performed. Patients belonging to the low-risk categories were identified after review of the records. Factors likely to influence the admission decision were noted. Descriptive statistics was generated. Results Eighty-five patients were identified, 61 (71.8%) females and 24 (28.2%) males. The mean age was 59.1 years (±17.3 years, SD). Fifty-three (62.3%) patients had at least one significant comordid condition (e.g. chronic lung disease, diabetes). Of the remaining patients, 20 (23.5%) had at least one identifiable factor (e.g. haemoptysis, multilobar infiltrates in chest radiograph) influencing the hospitalisation decision; and only 12 (14.1%) had no reason, identifiable retrospectively, to justify hospitalised care. Conclusions A substantial number of low-risk patients with CAP (classified according to the Prediction Rule) were admitted. Most of these patients had identifiable comorbid conditions and prognostic factors that had not been accounted for by the Prediction Rule guidelines. Further evaluation of the significance of these additional variables is required in order to give the guidelines a better predictive value.
A Study on the Use of Abdominal X-Ray in an Emergency Department
Authors: Choi Sy , Wong Tw , Lau Cc , Liang E , Fu Yk , Khoo J 
Published: December 2017

Objective 1) To study the current use of abdominal X-rays (AXR) in our emergency department (ED). 2) To evaluate the clinical predictors for positive AXR findings. Methods During the 40 days study period, all patients who had taken abdominal X-rays were included. The attending doctor filled in a questionnaire on demographic data, clinical features and outcome. The three radiologists who participated in this study reported the films and consultant emergency physicians then commented on the appropriateness of the request. The clinical features, which were predictive of positive radiological findings, were sorted out using univariate analysis. Results 64 patients were included in the 40 days study period. The rate for AXR request was 3.4 per 1000 patients. The most common presenting complaints were abdominal pain (85.9%) and constipation (45.3%). The most frequent clinical findings were abdominal distension (35.9%) and hyperactive bowel sound (31.3%). Only two of the clinical features, including vomiting and rebound tenderness, were found to have significant correlation with positive X-ray findings. Most of the AXR requests and interpretations by ED doctors were considered to be appropriate.
Study on the Discrepancies between the Admitting Diagnoses from the Emergency Department and the Discharge Diagnoses
Authors: Lim GH , Seow E , Koh G , Tan D , Wong HP 
Published: December 2017

Objective To study the extent of diagnostic discrepancies at admission (diagnoses made by doctors in the Emergency Department) and discharge (final diagnoses at the ward) in our Emergency Department (ED) where the doctors have direct admitting rights; and how such discrepant diagnoses affected inter-departmental transfer of patients after their admission. Method A non-concurrent cohort study was performed on admissions through our ED between 24th to 30th April 1997. The admitting and discharge diagnoses and units were recorded. The reasons for the unmatched diagnoses and inter-departmental transfers were studied. The significance of transfers amongst patients who had matched and unmatched diagnoses was compared using the Chi-test at 95% confidence interval. Results Three hundred and sixty-one admissions were recorded during the study period. There were 314 (86.7%) and 47 (13.3%) admissions with matched and unmatched diagnoses respectively. Nine of the 47 admissions with unmatched diagnoses and 16 of the 314 admissions with matched diagnoses were transferred (p=0.001). Conclusion The ED doctors achieved a high level of diagnostic accuracy. The most common reason for unmatched diagnosis was because of the difficulty of diagnosing the patient's complex medical problem in the short contact time in the ED. The level of accuracy should increase with the advent of more diagnostic modalities and increased contact time with the patients in the ED.
Analgesia for Adult Distal Radius Fracture Manipulation in the Emergency Department: Demand Valve Nitrous Oxide Compared with Intravenous Regional Anaesthesia
Authors: Goh PL , Lee SW , Goh SH 
Published: December 2017

Introduction This study compared demand-valve nitrous oxide (Entonox) with intravenous regional anaesthesia (IVRA) as analgesia in adults with distal radius fractures requiring manipulation and reduction (M&R) in the Emergency Department. Materials and methods All adults presenting to the Emergency Department of Changi General Hospital, Singapore between August to December 2000 with closed distal radius fractures requiring M&R were enrolled. Five parameters were measured: pain perception using visual analogue scale (VAS), patient acceptance, procedure time, complication rate and failed manipulation. Results Of the 67 patients enrolled, 32 received IVRA and 35 received Entonox. The average VAS was 2.2 cm for the IVRA group and 5.8 cm for the Entonox group (p<0.0001). The average procedure time was 25.6 minutes for the IVRA group and 11.1 minutes for the Entonox group (p<0.0001). Twenty-seven IVRA patients (84.4%) and 24 Entonox patients (68.6%) would agree to the same analgesia given similar circumstances (p=0.159). Four patients who received Entonox (11.4%) experienced minor complications, while no complications were noted in the IVRA group (p=0.115). Two patients who received IVRA (6.3%) and 8 patients who received Entonox (22.9%) required more than a single attempt at M&R (p=0.086). Conclusion The use of Entonox, compared to IVRA, was associated with significantly shorter procedure time but significantly higher pain scores, with no significant difference in terms of patient acceptance, complication rate or failed manipulation rate. Entonox is an effective analgesic alternative to IVRA in adult patients requiring M&R for distal radius fractures in the Emergency Department. Its use is ideal in situations where IVRA is unsuitable or contraindicated.
Female Trauma Patients in the Emergency Department: Should their Injury Prevention Programme be Different?
Authors: Chan KC , Seow E , Lau G , Chan SP , Tham KY 
Published: December 2017

Background(1) To compare the characteristics of female and male trauma patients seen in the Emergency Department (ED) and (2) to determine if injury prevention programmes for women should be different.MethodsA prospective survey was conducted for 11544 trauma patients, aged 15 years and above, who presented to the ED of an urban public hospital in Singapore over 6 months. The following data were collected: demography, place, type and mechanism of injury and subsequent disposition from the ED.ResultsAlmost half (49.5%) the injuries sustained by females occurred at home, with low falls of less than 2 metres being the most common mechanism of injury (52.7%). Victims of domestic violence were predominantly female at p<0.0001.ConclusionInjury prevention programs for women should focus on home safety and low falls. Special assistance programs for the victims of domestic violence should be available in the ED as the latter may be their only access to safety.
Severely Injured Patients Presenting to the Singapore General Hospital: a one Year Study
Authors: Lim YH , Yeo A , Koh MP , Wong CY 
Published: December 2017

Study objectivesTo determine the quantity and resource utilisation in management of the severely injured patients presenting at the Singapore General Hospital (SGH).MethodAll patients who were initially triaged to the hospital Emergency Department's (ED) resuscitation room and all trauma related mortality in the year 1998 were studied. All records were traced and the cases were followed up. Important outcomes studied were mortality and length of hospital stay.ResultsThree hundred and forty‐seven (0.2%) severely injured patients who were initially treated at the ED's resuscitation room were studied. The median age of the patients was 32 years old. Male patients formed 82.1% of the total. The three main causes of trauma in such patients were fall from height, motor vehicle related accidents and penetrating injuries caused by sharp instruments and firearms. Of all the patients, 62.8% were admitted to the ED between 1601 hours to 0759 hours and 30.5% of all severely injured patients were treated at the ED on weekends. One hundred and twenty three (35.4%) patients had emergency surgery within 24 hours of admission to the ED and 42.4% of the patients had an ISS score of 16 or more; 22.8% of patients had ISS score of 25 or more. The mortality of patients with ISS score of 25 or more was 39.2%.ConclusionOne percent of all new ED patients with trauma were classified as ‘severely’ injured and these occurred mostly outside “normal working hours”. There was significant mortality in patients with ISS score of 25 or more.
Hunger and Poverty among Elderly Patients Attending an Emergency Department
Authors: Tham KY , Poon SL , Thong SY 
Published: December 2017

BackgroundSingapore is an affluent small nation‐state with a high per capita gross domestic product.ObjectiveTo determine the prevalence of hunger and poverty among elderly patients attending an emergency department (ED).MethodsAll patients aged 65 years and above who sought treatment at the ED of an urban acute care hospital over one week between 0900 and 1700 hours were surveyed. Two trained interviewers administered a face‐to‐face close‐ended questionnaire. Data collected were demographics, health status and surrogate indicators of poverty and hunger.ResultsOf the 210 non‐critically ill patients approached, data was available for 194 (92.4%), of which 51% were men. The mean age was 76.7 (SD 7.4) years. Majority of the patients were well taken care of but a minority were not coping: 0.5% was homeless, 3.1% had skipped medical appointments in the last year due to lack of money, 1% did not have enough to eat and were not receiving any food aid and 1.5% borrowed money to buy food in the previous six months. Despite their advanced age, there were 12 (6.2%) who were sole breadwinners for their families. Twenty‐one patients (10.8%) were already on welfare assistance and 5.7% received food aid to supplement their basic food needs.ConclusionThough the numbers were not alarming, it was worrying that some elderly patients were going hungry or skipping medical appointments due to lack of money or still had family dependent on their income. The ED can help by actively identifying these at‐risk elderly and referring them for welfare assistance.
Predictive Value of a 6-Hour Ecg/Troponin Protocol in Patients with Chest Pain
Authors: Man CY , Cameron PA , Cheung WL 
Published: December 2017

Introduction Patients presenting with chest pain and considered to be at low risk of acute coronary syndrome (ACS) may still have coronary heart disease. The potential risk of sudden cardiac death due to arrhythmias or progression to acute myocardial infarction still exists. To minimize this risk, we have designed a 6-hour risk stratification protocol for patients with a low risk of acute myocardial infarction on initial assessment in the Accident and Emergency Department (AED). Materials & Methods This was a retrospective observational study with the aim of determining the risk of adverse cardiovascular events in chest pain patients attending an AED. These patients were subject to an ECG and cardiac troponin T tests (cTnT) at 0 hour and at 6 hours (if the two tests were negative at 0 hour), and were put under observation in the AED observation ward during the same period. The main outcome measures were adverse cardiac events at 30 days. Results A total of 371 Chinese patients considered to have low risk of ACS were recruited into the protocol. Troponin T tested positive in 19 patients (5.1%) at 0 hour and 8 patients (2.2%) at 6 hours. Amongst the 332 patients that were discharged directly from the AED, there were no re-admissions for cardiac-related deaths, acute myocardial infarction, arrhythmia or heart failure. Conclusion The 6-hour ECG and troponin T observation protocol is a useful tool to allow safe discharge of chest pain patients who are at low risk of acute coronary syndrome.
A Prospective, Randomised Clinical Trial Comparing Oral Diclofenac Potassium and Intramuscular Diclofenac Sodium in Acute Pain Relief
Authors: Ho MK , Chung CH 
Published: December 2017

Objectives To compare the efficacy of oral (PO) diclofenac potassium (Cataflam®) and intramuscular (IM) diclofenac sodium (Voltaren®) in acute pain relief, with a hypothesis of equivalence between the two. Patients and methods In this prospective randomised single center clinical study, adult Chinese patients attending the emergency department and suffering from renal colic, acute musculoskeletal injury or arthritis were enrolled. They were randomly assigned either 75 mg of IM Voltaren® or 75 mg of PO Cataflam®. Pain was assessed by the Visual Analogue Scale (VAS) and evaluations were performed at baseline, 30 minutes, 1 hour and 2 hours after treatment. Blood pressure, pulse rate and respiratory rate were also recorded at similar time intervals. Results We recruited 46 cases in the Voltaren® group and 45 cases in the Cataflam® group. Both treatment groups showed statistically highly significant reduction (P<0.0001) in pain VAS, systolic blood pressure and pulse rate compared with the baseline. Voltaren® was statistically more effective in pain relief at 30 minutes (P=0.012) and 1 hour (P=0.010) but not at 2 hours (P=0.311) compared with Cataflam®. The changes in blood pressure, pulse rate and respiratory rate were not statistically significant between the two treatment groups at all time points. Conclusion IM Voltaren® was more effective in acute pain relief compared with PO Cataflam®.
The Diagnostic Value and Cost-Effectiveness of Creatine Kinase-MB, Myoglobin and Cardiac Troponin-T for Patients with Chest Pain in Emergency Department Observation Ward
Authors: Choi YF , Wong TW , Lau CC 
Published: December 2017

Aim To evaluate the diagnostic value and cost-effectiveness of creatine kinase-MB isomer, myoglobin and cardiac troponin-T for patients with chest pain in emergency department observation ward. Method A prospective study was carried out to include all patients presenting with chest pain of suspected cardiac origin and admitted to the observation ward. Electrocardiogram and blood tests for the three cardiac markers were performed at the time of consultation and six to eight hours after admission to the observation ward. Progress of the patients was followed up for 30-day survival or the condition reviewed up to six months and the final diagnoses were documented. Result A total of 480 patients were recruited. The incidence of acute myocardial infarction was 1.5%. No one died of cardiac cause within 30 days. Troponin was more accurate than creatine kinase for diagnosing acute myocardial infarction and it was cost-effective. Myoglobin was of no value. Conclusion Troponin is recommended as a diagnostic tool for evaluating patients with chest pain in observation ward.
Emergent Cranial Computed Tomography in the Evaluation of Adult Non‐Trauma Patients in the Emergency Department
Authors: Lim HC , Wong EH 
Published: December 2017

ObjectivesTo study the utilisation pattern of head computed tomography (CT) for non‐trauma adult cases in an urban emergency department (ED) and the rate of clinically significant CT abnormalities. We also tried to identify any useful clinical indicators that could be used to predict abnormal scans.MethodologyA one‐year case series of adult non‐trauma cranial CT scans ordered in an urban ED was studied. Patients less than 16 years old, with CT head done prior to presentation and/or attendance precipitated by trauma were excluded. Logistic regression was used to identify significant predictors for abnormal scans. Clinical indicators that were studied included age, altered mental status (AMS), headache and vomiting, elevated blood pressure, previous history of hypertension, Glasgow Coma Scale (GCS) and presence of focal neurological sign (FNS).Results183 adult non‐trauma cranial CT scans were included in the study, and 109 (59.6%) CT scans revealed clinically significant abnormalities. Only AMS and FNS were found to be statistically significant in predicting abnormal scans. Patients with AMS had a 2.5 times (95% CI: 1.1 to 5.8) higher odds for an abnormal scan compared to those without AMS, adjusting for FNS. Patients with FNS had adjusted odds of 8.9 (95% CI: 4.2 to 18.8).ConclusionThis study reports a high (59.6%) rate of abnormal adult non‐trauma cranial CT compared with previous studies. Altered mental status and the presence of focal neurological sign are significant predictors for an abnormal scan. They should serve as useful criteria when devising utilisation strategies for emergency non‐trauma cranial CT in future studies.
Helicopter Evacuation: the Singapore General Hospital Experience
Authors: Lee JMH , Lim SH , Anantharaman V 
Published: December 2017

ObjectiveTo review the current state of helicopter casualty evacuations (helicasevac) in Singapore.MethodologyA retrospective study of helicasevac missions to the Singapore General Hospital over a 12‐year period from 1991 to 2002.ResultsOf the 297 casualties evacuated over 234 missions during the period, 90.2% (268/297) were trauma related and 9.8% non‐trauma. The majority of these trauma casualties were military national servicemen with heat injuries (63.4%, 170/268), followed by external injuries (25.0%, 67/268). The most common medical referrals were for cardiovascular or neurological conditions. Most of the patients brought in were critically ill, unconscious or semiconscious. Most were admitted (88.2%, 262/297). None of the 19 patients who collapsed and were without signs of life prior to helicopter transport survived attempted resuscitation at the emergency department. The usefulness of transferring them with helicopter is doubtful. The on‐scene diagnosis and inpatient diagnosis for the patients were consistent in 98.6%. The air evacuation mission locations were mainly from the surrounding islands of Singapore ‐ 58%, while 17% were from ships traversing the nearby straits e.g. the Straits of Malacca and South China Sea and 19% were from military camps within mainland Singapore.ConclusionThe criteria for despatching helicopters for air evacuation in Singapore have not been established. There are benefits in terms of transport time and bringing on‐site medical care to casualties at distant offshore locations. The benefit of evacuating urban patients by helicopter is doubtful, especially if they are already in cardiopulmonary arrest.
How Efficient can we Treat Presumed Acute Uncomplicated Lower Urinary Tract Infection in Women with 3-Day Antibiotic in the Accident & Emergency Department?
Authors: Li YW , Yuen WL 
Published: December 2017

Introduction Urinary tract infection is a common problem in females encountered in the Accident & Emergency Department. The increasing prevalence of Escherichia coli and other urine isolates resistant to trimethoprim-sulfamethoxazole and ampicillin enhances the use of nitrofurantoin as the first line therapy. A guideline of 3-day antibiotic in presumed uncomplicated cystitis has been proved to be of improved cost-effectiveness. Objective To study the outcome and efficiency of 3-day antibiotic treatment in presumed acute uncomplicated cystitis in women in the Accident & Emergency Department. Methods This was a prospective study on women aged 18–55 years with presumed uncomplicated cystitis from January to June 2004. A telephone survey was conducted to assess the clinical response, adverse effect and compliance of the treatment. Results Initially 83 patients were recruited in the study, but only 76 patients' outcomes could be traced by telephone survey and the computer system in public hospitals. Fifty-eight patients (76.3%) had good clinical response with symptoms resolved usually on day 2. Though 48.1% of the patients reported side effects with mainly gastrointestinal discomfort, most were mild and tolerable. The overall compliance was above 80%. Conclusion Three-day nitrofurantoin is an effective, inexpensive treatment for acute uncomplicated cystitis, which is a common disorder in females. Guidelines on the management of this large group of patients would help to conserve health care costs, improve compliance and reduce the emergence of resistance strains.
A Six-Year Prospective Study of Out-of-Hospital Cardiac Arrest Managed by a Voluntary Ambulance Organisation
Authors: Chung CH , Wong PCY 
Published: December 2017

Objective To obtain a database on the epidemiology of prehospital cardiac arrest and its management by a voluntary ambulance service, with the view for developing future strategies and service improvement. Design A 6-year prospective study from December 1998 to November 2004, using the Utstein-style template. Setting A voluntary ambulance service in Hong Kong. Subjects and methods Ambulance members had to complete and submit a specially designed data form after managing a cardiac arrest case, together with the ambulance run record and the automated external defibrillator (AED) computer printout, if appropriate. Main outcome measures Survival to hospital discharge and return of spontaneous circulation after resuscitation. Results A total of 72 cardiac arrests occurred during the period, with patients' age ranging from 29 to 106 years (mean 73.4). Most cardiac arrests occurred at home (46 or 63.9%). There were 58 witnessed cardiac arrests (80.5%), but bystander cardiopulmonary resuscitation (CPR) was started in only nine cases (15.5%) before the arrival of the ambulance crew. Six patients had evidence of rigor mortis or dependent lividity on ambulance arrival. For the 61 patients with electrocardiogram strips, the initial presenting rhythm on the AED was asystole in 45 (73.8%), pulseless electrical activity in 5 (8.2%), and ventricular fibrillation (VF) in 11 (18.0%). The median call-to-arrival time for VF cases (4.0 minutes) was significantly shorter than that of non-VF rhythms (8.5 minutes) [Mann-Whitney U test p=0.008]. Five patients had return of spontaneous circulation after resuscitation, but only one survived to hospital discharge. Conclusions Bystander CPR and ambulance response time are two areas requiring urgent improvement in our locality. As the majority of cardiac arrests occurred at home, the cost-effectiveness of public access defibrillation for Hong Kong is unclear. However, strategic placement of AED at high incidence' locations should be seriously considered.