bluuebunny/crossref_metadata_2025_split huggingface dataset:
Noninvasive Ventilatory Support in Emergency Department: Initial Experience in Hong Kong
Authors: Tang Hm , Lau Fl 
Published: December 2017

Background and Method There is favourable evidence supporting the use of noninvasive ventilatory support (NIV) in Emergency Department (ED) in treating patients with non-traumatic acute respiratory distress (ARD). To determine the feasibility and potential uses of NIV in the ED of Hong Kong, a prospective study was done in the ED of a regional acute hospital. A convenience sample of patients with non-traumatic ARD was recruited within the first 3 months after the introduction of this modality of therapy. Haemodynamically unstable or uncooperative patients and those requiring immediate endotracheal intubaton (ETI) were excluded. Patients were placed on BiPAP noninvasive ventilator with face mask for at least 30 minutes in ED. Blood pressure, respiratory rate and arterial blood gases analysis were recorded before and after the therapy. Adverse effects of NIV in ED, necessity of ETI and hospital mortality were also recorded. Results 28 patients were studied. The mean age was 76 years old (range 56–98). Causes of ARD included acute exacerbation of chronic obstructive airway disease (COAD, n=14), acute pulmonary oedema (APO, n=10) and bronchopneumonia (n=4). Patients were put on either Continuous Positive Airway Pressure (n=7) or Bilevel Positive Airway Pressure (n=21) modes of NIV. The COAD and APO groups responded favourably. The bronchopneumonia group showed only borderline or no improvement and 2 patients in this group needed ETI in ED, in contrast to only 1 patient in APO group and nil in COAD group. Only minor discomforts were felt by patients but no major adverse effect was observed. Two patients (2/4=50%) in bronchopneumonia group died from the disease. Conclusion NIV delivered in ED is feasible and is likely to be beneficial to patients with ARD due to COAD or APO. Further randomised controlled trials should be conducted to explore its potential uses in ED. (Hong Kong j.emerg.med. 2001;8:140–145)
A Retrospective Study of Patients Discharged within 24 Hours after Emergency Admission in a Public General Hospital
Authors: Cheng SST , Chung CH 
Published: December 2017

Objectives To identify the epidemiological characteristics and outcome of patients who were discharged within 24 hours of emergency admission, and to explore methods to reduce inappropriate admission. Design Retrospective study. Setting Emergency admission in a public general hospital in Hong Kong. Patients Four hundred and ninety-one cases collected in a three-month period from 1st April 2000 to 30th June 2000, excluding those who died within 24 hours of admission. Main outcome measures Patients' epidemiological and clinical characteristics, specialty of admission, in-patient procedures performed, diagnosis upon discharge and destination of patients. Results During the study period, 8.8% of the 5,587 emergency admissions were discharged within 24 hours. Most of them were middle-aged males, triaged as category 3 and 4 non-trauma cases. The percentage of emergency Orthopaedic and Surgical admission resulting in discharge within 24 hours was 18.5% and 16.2% respectively, substantially higher than the percentage of emergency Medical and Paediatric admission (5.5% and 4.7% respectively). The most common diagnoses included orthopaedic open soft tissue injuries, orthopaedic closed fractures and dislocations, head injury, drug overdose, abdominal pain, ischaemic heart disease or chest pain and foreign body in throat. Overall, 20.8% of cases received some forms of orthopaedic procedures, 9% had computed tomography (CT) brain done, and 5.5% had OGD performed. Around 90% of cases with orthopaedic open soft tissue injuries and closed fractures or dislocations received intervention, 73% of head injury cases had CT brain done, and around 63% of patients with foreign body in throat received oesophago-gastroduodenoscopy (OGD). Overall, 14% of cases discharged themselves against medical advice or walked away after admission. Up to 9.8% were transferred to other hospitals within 24 hours. Around 54.8% were followed up in hospital after discharge, and re-admission was planned in 2.9% for elective procedures. Only 13 cases (2.6%) were re-admitted through A&E within one week with the same diagnosis into the same specialty. Conclusions The issue of ‘discharge within 24 hours’ should not automatically be regarded as inappropriate emergency admission. Upgrade of professional training and clinical supervision, improvement of administrative arrangement and clinical audit are possible measures to enhance the efficiency of hospital utilization.
Application of APACHE II in the Assessment, Classification of Severity and Predictive Ability of Chinese Patients Presenting to an Emergency Department Resuscitation Room
Authors: Lee CK , Rainer TH 
Published: December 2017

ObjectivesTo evaluate the use of APACHE II (Acute Physiology and Chronic Health Status Evaluation) in Chinese patients managed in the resuscitation room of an Accident & Emergency Department of one of the teaching hospitals in Hong Kong.DesignProspective study on Chinese patients.SettingResuscitation Room in an Accident & Emergency Department of a university hospital in Hong Kong.Patients and measurementsConsecutive patients managed in the resuscitation room between 14th August, 2000 and 20th August 2000 (excluding patients younger than 18 years old and patients who were not admitted to hospital after initial assessment and treatment). For each patient, demographic data, diagnosis, the chronic health points, and the worst physiological parameters in the A&E resuscitation room were recorded. The total APACHE II scores and the probability of death were calculated. The accuracy of APACHE II for predicting group mortality was assessed by receiver operating characteristic curve analysis and linear regression analysis.ResultsOf the 88 patients included in the study, 13 (15%) died and 75 (85%) survived. Significant factors associated with mortality included age, mean arterial pressure, heart rate, respiratory rate, arterial pH, serum sodium, Glasgow coma score, and chronic health points. For the three scoring subdivisions of APACHE II – total APS score, age points and chronic health points – higher mean values were found in those patients who died compared with patients who survived. Using logistic regression analysis, the APACHE II score determined in the emergency resuscitation room is a strong predictor of mortality (r2=0.712). At a cut off score of >28 the sensitivity is 100.0% (95% CI 100.0–100.0), specificity is 68.0% (95% CI 56.2–78.3), positive likelihood ratio is 3.13, positive predictive value is 35.1 and negative likelihood ratio is 100.0. Analysis of the ROC curve reveals an area under the curve of 0.910 (95% CI 0.829–0.960). In patients not admitted to ICU, there was a positive correlation between APACHE score and length of hospital stay in patient who survived (r=0.320, P=0.0075) and a negative correlation between APACHE score and length of hospital stay in patients who died (r=-0.760, P=0.0225).ConclusionsThe APACHE II scoring system may be usefully applied in emergency departments for predicting mortality, for classifying and assessing severity of disease, for evaluating performance and for planning departmental resource allocation.
Emergency Department Violence: a Local Scene
Authors: Chung CH 
Published: December 2017

ObjectivesTo study the nature, frequency and magnitude of violence in a local emergency department.DesignProspective epidemiological study in a three‐month period, during which involved staff filled in a survey form immediately after violence incidents.SettingAccident & Emergency Department of a public general hospital in the northeastern New Territories.PopulationAssailants and victims of violence in the emergency department.Main outcome measuresNature of violence, frequency, cause, morbidity, epidemiological characteristics of assailants and victims.ResultsThere were 25 incidents with 26 assailants in the three‐month period. The great majority was verbal abuse only (64%). No weapon was involved. Long waiting time (36%), deranged mental condition (28%) and dissatisfaction with service (20%) were the leading causes of violence. Assailants showed a predominance of male (69%) and age between 21–50 years. They were either patients (69%) or accompanying persons (31%). Nurses (59%) and to a lesser extent doctors (23%), were the main victims.ConclusionThe incidence of emergency department violence (0.08%) was low and the majority was verbal abuse only. Nurses bore the brunt of the violence. Long waiting time, confused patients and dissatisfied patients were high risk factors.
A Comparison of Emergency Department Admission Diagnoses and Discharge Diagnoses: Retrospective Study
Authors: Chiu HS , Chan KF , Chung CH , Ma K , Au KW 
Published: December 2017

ObjectiveTo study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy.DesignRetrospective study in a two‐month period.SettingAccident & Emergency Department of a public general hospital, which had four in‐patient specialties – Medicine, Surgery, Paediatrics and Orthopaedics.SubjectsAll cases admitted through the emergency department in the study period.Main outcome measuresDegree of correlation between emergency department admission diagnosis and hospital discharge diagnosis.ResultsOf all admission diagnoses, 71.4% fully or partially matched the final discharge diagnoses. The accuracy of diagnosis was statistically better in traumatic cases, the male sex and young adults. Diagnostic accuracy varied with the specialty involved and investigations taken.ConclusionHistory and physical examination remained the most important diagnostic tools in the emergency department. In general, simple investigations available at the emergency department were not helpful in improving diagnostic accuracy.
An Outcome Study on the Management of Alleged Fish Bone Ingestion Using Fibre-Optic Endoscope by Emergency Physician
Authors: Ma KK , Yuen WL 
Published: December 2017

Background Patient with alleged fish bone ingestion with negative oropharyngeal examination requires an upper gastrointestinal (GI) endoscopy for definitive care. Aim To study the competency and cost-effectiveness in patients with alleged fish bone ingestion using fibre-optic endoscope by emergency physician. Method A retrospective study in patients with endoscopy for alleged fish bone ingestion for a period of six months from January to June 2001. A telephone survey was conducted specifically asking for post-endoscopy or fish bone ingestion related complications. Results Ninety-six patients were recruited in the study. There were 42 males and 54 females with a ratio of 1:1.3. The detection rate was 32%. Eighty-seven percent of the fish bones was retrieved, and 13% was dislodged. Over 90% of fish bones were found in oropharynx and laryngopharynx. In the telephone survey, 81 patients (84.4%) could be contacted by phone and they experienced uneventful outcome after endoscopy. Of those who could not be contacted, there was no documented attendance or admission in any other hospital (under Hospital Authority) according to the computer records in Clinical Management System. Ninety-six hospital bed-days, which were equal to $350,400, could be saved under our approach in alleged fish bone ingestion without admitting patients into surgical unit for treatment. Conclusion Emergency physician was competent enough in performing upper GI endoscopy, and this method of managing alleged fish bone ingestion was shown to be safe and cost saving.
How Evidence-Based is our Practice in a Hong Kong Emergency Department?
Authors: Pang PKM , Lim B , Lee KP , Lok CL , Chung CS , Ngan HK 
Published: December 2017

ObjectiveTo evaluate how evidence-based our daily practice was.DesignRetrospective study.SettingEmergency department of a public district hospital.Patients and MethodsBetween 1st August 2000 to 7th August 2000, 91 patients' records were chosen at random. A chief diagnosis was assigned for each patient. Corresponding treatments were reviewed by searching relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses. Each patient had only one chief diagnosis but could have multiple interventions for that diagnosis.ResultsOut of 91 records, 14 were discarded. All of them had not been given any intervention and 11 required admission. For the remaining 77 records, there were 38 subjects in medical, paediatric, or gynaecological specialties and 39 in surgical or orthopaedic specialties. Intervention(s) given for each subject were then searched electronically through our hospital Knowledge Gateway and the results were expressed as either EBM-positive or EBM-negative. “EBM-positive” interventions denoted a support by RCTs. “EBM-negative” interventions denoted an absence of any supportive RCTs. Each patient might have EBM-positive and/or EBM-negative interventions together if that patient received more than one treatment. There were 52 patients (52/77 = 68%) who had one of their interventions being RCT-supported. The majority were patients with (1) antipyretic use of paracetamol in upper respiratory tract infection, or (2) control of pain by nonsteroidal anti-inflammatory drug, dologesic and paracetamol. There were 25 patients (25/77 = 32%) who did not receive any RCT-supported interventions. Concurrently 53 patients out of 77 (69%) received EBM-negative interventions. The majority were patients with (1) the use of antibiotics, antitussives and antihistamines in upper respiratory tract infection, (2) antispasmodics in gastroenteritis or patients with nonspecific abdominal pain, and (3) the use of analgesic balm in minor orthopaedic complaints.ConclusionSixty-eight percent of patients had EBM-positive interventions. Thirty-two percent of patients did not receive any EBM-positive intervention. It was quite encouraging as compared to studies in other specialties with similar design. Concurrently 69% of patients had also been given EBM-negative interventions. There were areas for improvement if we were to implement EBM practice in the emergency department.
A Case Series of Using Aspiration Catheter for the Management of Spontaneous Pneumothorax
Authors: Siu AYC , Chung CH 
Published: December 2017

Introduction Catheter aspiration is a relatively new treatment for spontaneous pneumothorax in emergency departments in Hong Kong. It causes less pain and shortens hospitalisation. However, there is limited local experience especially in regard to the target group that can be benefited. We reported on the initial experience of catheter aspiration in the management of spontaneous pneumothorax in our emergency department. Method Patients (age >=16 years) presenting with spontaneous pneumothorax were recruited. Patients with history of asthma or chronic obstructive airway disease were excluded. History of smoking, previous pneumothorax and pleurodesis were recorded. The aspiration catheter was inserted by the Seldinger technique. The extent of pneumothorax was assessed from the chest X-ray and initial aspirated volume. Successful patients were observed in the department and discharged if chest X-rays were reassuring after 12 hours. Factors associated with the outcome of patients were analysed. Result Seventeen patients were recruited from October 1999 to September 2000. Their age ranged from 16 to 40 years (mean 22.6). The overwhelming majority (16) was male. Twelve cases (70.6%) occurred on the left side. Five patients had previous pneumothorax and one had previous pleurodesis. Fifteen succeeded in immediate re-expansion, but seven re-collapsed during observation. The overall success rate was 47.1%. Initial aspiration volume >2,000 ml was associated with early failure (p=0.01). Conclusion Our initial experience did not support catheter aspiration to completely replace chest drain in the initial management of spontaneous pneumothorax. The procedure is likely to fail if the initial aspirated volume is greater than 2,000 ml. Further study is needed to identify the subgroup that may be benefited.
Thrombolysis as a Therapeutic Modality in Cardiac Arrest
Authors: Tay SY 
Published: December 2017

Introduction In recent years, thrombolysis has emerged as a potentially promising treatment for cardiac arrest. Patients with cardiac arrests from myocardial infarction or pulmonary embolism, as well as out-of-hospital cardiac arrests, were reported to have improvement in both survival and neurologic outcome after being treated with thrombolysis. This paper aims to review the available literature on the use of thrombolysis in cardiac arrest. Method Study of papers from PubMed literature search for all articles with terms related to thrombolysis and cardiac arrest in title or abstract. Results Thrombolytics are thought to act by lysing both macroscopic clots and microthrombi, particularly in the cerebral microcirculation, thus alleviating or reversing post-arrest cerebral no-reflow. Their use in cardiac arrest has been restrained by concerns over their safety after cardiopulmonary resuscitation, in particular bleeding-related complications, although these concerns seem to have been misplaced. Conclusions Thrombolysis for cardiac arrest is likely to be most efficacious in a pre-hospital environment, and future research should be directed to this setting.
A Retrospective Study of Seclusion in an Emergency Department
Authors: Chan CC , Chung CH 
Published: December 2017

ObjectivesTo study the practice of seclusion in an emergency department (ED) and to explore high‐risk elements during seclusion.MethodsThe study consisted of two parts: an in‐depth analysis on all incidents associated with seclusion in a six‐year period (1998–2004) and a two‐year (2002–2004) retrospective analysis of secluded patient records to understand the rationale and patient outcome.ResultsPart 1: A total of 9 incident records were collected. Four patients were related to setting fire. Five patients had violence or threat of violence. The median length of stay (LOS) in seclusion at the time of incident was 129 minutes. Although 66.7% of the patients had additional restraint prior to the seclusion, incidents still occurred. Two staff sustained injuries and hospital facilities were damaged in some of the incidents. Six patients were later admitted to psychiatric hospital. Part 2: 141 patient data were collected in the study (M: 89 and F: 52). The average monthly number of patients secluded was about 6. The mean age was 45 years (SD 19) and the mean LOS was 616 minutes (SD 478). There were three incidences (2.1%) during the two‐year period. A total of 82 patients (58.2%) were associated with violence or threat of violence and 38 (46.3%) of the group had psychiatric illness; and 50 patients (35.5%) were associated with alcohol or drug intoxication. Ultimately, 56 patients (39.7%) were admitted to psychiatric hospital and 64 patients (45.4%) were treated and discharged from the ED.ConclusionSeclusion is a high‐risk practice. In our department, the most frequent indication was violence (58.2%), with nearly half of them having history of psychiatric illness. Psychiatric illness had the highest risk for incidents, especially those with violence or threat of violence. The LOS in seclusion was relatively long in the ED and might be one of the risk factors for incidents. Inadequate removal of potentially dangerous belongings from patients before seclusion may end up with catastrophic outcomes. Curiously, ED nurses are not allowed to search patients before seclusion. They are exposed to legal liability in exercising restraint and in searching for potentially dangerous items from patients. It is suggested that clear protocols and quality assurance programs should be instituted to ensure safe seclusion.
The Prevalence of the Male Pattern in Electrocardiograms of Healthy Chinese Adult Males in Hong Kong
Authors: Ho JKK , Lee KH , Tsui CSY , Ko HF , Lit CH 
Published: December 2017

Introduction The main feature of the male pattern in electrocardiograms (ECG) is ST-elevation at the J-point of >0.1 mV in at least one of the leads V1–4 with concave upward ST-segments. The prevalence of the male pattern in ECG of healthy male foreigners who were 16–58 years old (mostly Caucasians or Blacks) was high (85%). These ST-segment elevations may meet the ECG criteria for fibrinolytic therapy according to the present guidelines for the treatment of ST-elevation myocardial infarction (STEMI), thus resulting in potentially inappropriate management. Clinicians should be aware of this common phenomenon. As yet, the prevalence of the male pattern in healthy Chinese adult males has not been studied specifically. Materials and methods Standard 12-lead ECG from 202 apparently healthy Chinese adult males (aged 20–54) were collected and analysed. Results The prevalence of the male pattern was 95.5% in our 202 samples (p<0.05). Of these samples of male patterns, 97.4% might have met the ECG criteria for fibrinolytic therapy according to the guidelines of the American College of Cardiology and American Heart Association (2004); but if we followed the guidelines of the European Society of Cardiology (2003), only 21.8% met the criteria. Conclusions The prevalence of the male pattern in ECG of healthy Chinese adult males in Hong Kong is high. Clinicians should be more cautious while managing patients with possible acute coronary syndrome to avoid over-diagnosis of STEMI. It seems the European guidelines are safer to follow as regard to the prescription of fibrinolytics for STEMI, especially for junior doctors.
A 6-Year Epidemiological Study of Pulmonary Embolism in an Emergency Department
Authors: Cheng CC , Chung CH 
Published: December 2017

Objective To identify the epidemiology and early clinical features of patients with pulmonary embolism with a view to facilitate making the correct diagnosis. Methodology A retrospective study of patients admitted through the emergency department with a discharge diagnosis of pulmonary embolism in the computerised Clinical Management System from 1st January 1999 to 31st December 2004 in a public emergency general hospital in Hong Kong. Results Twenty-two patients were newly diagnosed to have pulmonary embolism and included in the study. The patients' clinical features and investigation findings were analysed. Old age and immobilisation were the most common risk factors identified. Nine patients were found to have deep vein thrombosis but none of them complained of calf pain during consultation in the emergency department. Most patients had symptoms of shortness of breath and chest pain on presentation. Fourteen patients had type 1 respiratory failure. The electrocardiogram and chest X-ray findings were non-specific. All the patients with D-dimer done showed positive results. CT scans were used in all patients to make the final diagnosis. Nineteen patients received low molecular weight heparin followed by warfarin and three patients had thrombolytic therapy. Conclusion Pulmonary embolism is not a commonly diagnosed disease in Hong Kong. The symptoms are non-specific and it is difficult to make the correct diagnosis in the emergency department.