bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shorter Symptoms Onset to Emergency Department Presentation Time Predicts Failure of Needle Aspiration in Primary Spontaneous Pneumothorax
Authors: Law PK , Lui CT , Lee MM , Tsui KL , Tang YH 
Published: December 2017

Objective To evaluate factors in predicting the failure of needle aspiration in primary spontaneous pneumothorax, in particular the interval between symptom onset and emergency department presentation. Methods This is a retrospective cohort study carried out from January 2010 to October 2012 in two public hospitals in Hong Kong. All consecutive adult patients aged 18 or more who attended the emergency departments in the study period with the diagnosis of primary spontaneous pneumothorax, where needle aspiration was performed as the primary treatment were recruited. Age, smoking status, previous pneumothorax, symptom interval, size of pneumothorax and aspirated gas volume were included in the analysis. The outcome was successful or failed needle aspiration. Logistic regression was used to identify independent predictors of failed needle aspiration. Results A total of 196 patients were included. Overall, 105 patients (53.6%) were treated successfully with no recurrence upon discharge. Among those failure patient, 30 patients (15.3%) failed as evidence by the chest X-ray taken immediately after the procedure while 61 patients (31.1%) failed upon subsequent chest X-ray. Multivariate logistic regression showed factors independently associated with failure of needle aspiration included size of pneumothorax (apex to cupola distance) (odds ratio [OR]=1.022, 95% confidence interval [CI]=1.009-1.039, p=0.001) and symptoms onset to emergency department presentation time (OR=0.987, 95% CI=0.976-0.999, p=0.028). Conclusions Large pneumothorax and shorter symptoms onset to emergency department presentation time were associated with higher failure rate of needle aspiration for primary spontaneous pneumothorax. (Hong Kong j.emerg. med. 2014;21:16-22)
Usefulness and Problems of Intraosseous Infusion with the Bone Injection Gun™ Using Simulators Under Confined Space Conditions
Authors: Isayama K , Hirakawa A , Tsuda M , Nakatani T 
Published: December 2017

Introduction It is important to have a venous line for infusion as an emergency treatment for patients suffering from crush syndrome or bleeding under confined space (CS) conditions in disaster medicine. However, it is not easy to for Emergency Life-Saving Technicians (ELSTs) to establish a venous line in such settings. Although previous studies have described the use of mechanical intraosseous (IO) devices and IO access while wearing chemical protection gears, problems for the use of IO devices under CS conditions have not been considered. This study aimed to investigate usefulness and problems of using a Bone Injection Gun™ (BIG) for IO infusion by ELSTs and rescue workers in CS conditions. Methods The time required and success rate for IO infusion using a BIG in a manikin leg were measured, and for administering intravenous infusion in a manikin arm using either rescue gloves or plastic gloves by ELSTs or rescue workers under CS conditions. Results Wearing rescue gloves, ELSTs were significantly faster in placing intraosseous infusion (IOI) compared with rescue workers. The success rate of the placement was not significantly different between ELSTs and rescue workers whether or not they wore rescue or plastic gloves. Conclusions Although the finite usefulness of IOI with BIG under CS conditions is indicated, some problems such as the timing of removal of the IOI and difficulty in finding the location of the trocar needle after activating BIG are pointed out. Therefore, there are rooms to consider using IOI with BIG under CS condition. (Hong Kong j.emerg. med. 2014;21:23-30)
Risk Factors of Early Seizure Recurrence in Epileptic Patients Presented to an Emergency Department in Hong Kong
Authors: Chau YM , Mok KL , Wong YT , Kan PG 
Published: December 2017

Introduction While epilepsy is a well-known disease, little is known about early recurrence of seizures, and some patients are admitted to medical ward for the risk of recurrence of epilepsy. The aim of this study was to determine the frequency and risk factors of early seizure recurrence (ESR) among the epileptic adult patients attending the emergency department (ED). Methods In this retrospective observational study, medical records of all patients presenting to a regional ED in Hong Kong with seizures from 1 January 2010 to 31 December 2011 were reviewed. Their demographic data and clinical features were analysed to look for the relationship with ESR. ESR was defined as a seizure recurrence during the first 24 hours since the last seizure. Results A total of 339 patient records were analysed. The ESR rate was 13.7% at 24 hours and 80% occurred in the first six hours after the last seizure. Age≥40, female sex, repeated seizure in past one day, and abnormal plasma sodium and calcium levels were found to be statistically significantly associated with ESR by univariate analysis. These risk factors remain statistically significant after repeated multivariate logistic regression analysis. Conclusion The ESR rate is about 13.7% in our emergency department setting and 80% of them occur within six hour since their last seizure. Five risk factors, namely age group, sex, repeated seizure in past one day and abnormal blood sodium and calcium level are significant factors associated with ESR. We conclude that it is not necessary to admit all the adult epileptic patients with simple breakthrough seizures to hospital. (Hong Kong j.emerg.med. 2014;21:37-43)
Spontaneous Rupture of Abdominal Aorta after Seizure in a 23‐Year‐Old Woman: A Case Report
Authors: Paik JH , Jung HM , Yun SH , Lee JS , Han SB , Kim JS , Kim JH 
Published: December 2017

Spontaneous non‐aneurysmal aortic rupture is a rare and life threatening clinical entity. A 23‐year‐old female patient who visited a nearby hospital due to intractable seizure was transferred to our hospital with the impression of hypotension and decreased level of haemoglobin. She had a history of seizure attacks once a month. However, in the 2 weeks before presentation, the frequency of seizure attacks had increased to 2 to 3 times a day. An abdominal‐pelvic computed tomogram scan showed extravasation of contrast from the abdominal aorta at L3 level. An emergency laparotomy revealed a 0.3 cm diameter tear in the posterior wall of the aorta, superior to the iliac bifurcation. We discuss the mechanism of spontaneous aortic rupture and the possibility of aortic rupture related to seizure attacks. (Hong Kong j.emerg.med. 2014;21:103‐106)
Management and Short‐Term Follow‐Up Study of Transient Ischaemic Attack Patients in a University Teaching Hospital
Authors: Zhang LH , Wen ZM 
Published: December 2017

ObjectiveThe aim of this study was to describe the management of patients admitted to a university teaching hospital in China who were diagnosed of having transient ischaemic attack (TIA) and to determine the outcome within a 7‐day and 90‐day period.MethodsA retrospective, hospital‐based study included consecutive patients having TIA from July 2009 to February 2013 was performed. Demographic data, risk factors, symptoms, clinical management, ABCD2 scores were analysed. The main outcome variable was the occurrence of TIA and ischaemic stroke during the 7 and 90 days follow up periods.ResultsA total of 157 patients were evaluated. After excluding 3 patients (1.9%) because they were lost to follow‐up, 154 patients were included in the study. All patients underwent a cranial computed tomogram (CT) to exclude intracranial haemorrhage. If the cranial CT scan result was negative for bleeding or other diagnoses, further comprehensive tests would be initiated following a standardised clinical assessment protocol at the time of hospitalisation. Totally 148 (96%) patients received antiplatelet therapy and 6 (4%) patients received anticoagulation therapy. Eight (5.2%) patients received stenting therapy. Only 3 (1.9%) and 6 (3.8%) TIA patients developed subsequent TIA within 7 days and 90 days respectively. Twelve (7.8%) TIA patients developed ischaemic stroke within 7 days and 19 (12.3%) within 90 days. All the 6 patients who had recurrence of TIA within 90 days proceeded to develop ischaemic stroke. The ABCD2 scores of patients experienced subsequent TIA and ischaemic stroke (4.94±1.39, n=19) were significantly higher than those of patients without recurrence (3.91±1.37, n=135; p<0.05). None of the patients who received stenting therapy developed subsequent TIA or ischaemic stroke during the follow up period.ConclusionsOur findings suggest that in‐patient evaluation and management of TIA may be a safe and effective strategy. Rapid diagnosis and implementation of treatments for TIA patients are crucial to reduce stroke risk. (Hong Kong j.emerg.med. 2014;21:92‐97)
Dynamic Internet-Mediated Team-Based Case Management of High-Frequency Emergency Department Users
Authors: Chiang CY , Lee CW , Tsai TC , Li CJ , Lee WH , Wu KH 
Published: December 2017

Introduction We assessed whether a strategy using dynamic, internet-mediated, team-based case management could reduce the number of subsequent emergency department (ED) visits by frequent ED users. Methods Patients who attended the ED three or more times within 72 hours in June 2010 were identified. These cases were divided into the pain management or chronic disease group according to their chief complaint. Patients were assessed by expert panels, and initial care plans were developed and posted on an internal website. Thereafter, each emergency physician could follow or adjust the care plans dynamically via the internal website according to the patient's condition and use the website to communicate results. Care plans were revised by the team according to the patient's clinical situation as it changed. Patient ED visits over the subsequent six months were monitored. Results Fourteen cases were enrolled in the study, seven in each group. The mean number of visits per patient per month in the pain management and chronic disease groups decreased from 14.9 to 5.79 (p=0.031) and 6.1 to 2.9 (p<0.001) visits per month after the intervention, respectively. The overall mean number of visits per patient per month decreased from 10.5 to 4.36 (p=0.004), a decrease of 6.14 visits (58.27%). Conclusions Dynamic internet-mediated team-based case management may help to reduce subsequent visits in patients who frequently visit the ED. (Hong Kong j.emerg.med. 2014;21:161-166)
Fluid Restriction for Treatment of “Fluid Creep” after Acute Burn Resuscitation
Authors: Tang YW , Chen IC , Yen JH , Lu CT , Lai CS , Liu HJ , Chang HC , Chen YW 
Published: December 2017

Objective Fluid creep in patients recovering from acute burns still exists, despite the use of a more treatment conservative approach. Most of our severe burn patients develop fluid overload and body weight increase after acute fluid resuscitation. How to quickly return patients to their pre-injury body weight is an important issue. Methods Right after acute fluid resuscitation, we applied a “total fluid requirement” volume (usually 1/2 to 2/3 of initial 24 hour volume) and strictly monitored patients' hourly urine (between 0.5-1 ml/kg/hr). Patients' responses (body weight, enteric feeding amount, pulmonary condition, etc.) were also closely monitored and frequent adjustments of fluid volume administration were performed simultaneously. Results Most patients regained their pre-injury body weight within 2-3 weeks. Enteric feeding also improved markedly. No patients had severe oedema-related complications. Conclusions Stricter fluid administration after acute burn fluid resuscitation is advised for allowing patients to reduce body weight to their pre-injury weight or at least close to it. We use pre-injury body weight, enteric feeding and urine output as our guides. (Hong Kong j.emerg.med. 2014;21:222-229)
Influence of Automatic Compression Device and Water Rescue Equipment in Quality Lifesaving and Cardiopulmonary Resuscitation
Authors: Barcala-Furelos R , Abelairas-Gomez C , Romo-Perez V , Palacios-Aguilar J 
Published: December 2017

Introduction The purpose of this study was to analyse how the rescue equipment and the automatic compression mechanism influenced the cardiopulmonary resuscitation (CPR) after a water rescue on the beach. Methods The sample of our research composed of a group of 65 lifeguards (51 men and 14 women). The lifeguards carried out a 5 minute CPR pretest. Afterwards, the sample was randomly divided into two groups. Both groups performed a test: a water rescue, and immediately afterwards 5 minutes of CPR. One group did not have any additional rescue material, while the other used flippers and a rescue tube to swim. The group with the rescue material performed a CPR with an automatic compression mechanism, the Lund University Cardiac Arrest System. Results The use of the automatic compression device improves the conditions in the correct compressions in CPR after a water rescue: (manual: 283±145.25; automatic: 352±119.74, p=0.042). There was no significant difference in the correct breathing (p=0.758). During the water rescue the lifeguards equipped with flippers and a rescue tube were faster (227±69.28 s) than the lifeguards who had not used any additional equipment (271±43.06 s, p=0.003). Conclusion The use of flippers and rescue tube improved the rescue time. The CPR quality when the lifeguard was exerted worsened significantly, but the use of the automatic mechanisms of compression improved the performance of quality chest compressions. This was not the case with the ventilations, these being of poor quality in both groups. (Hong Kong j.emerg.med. 2014;21:291-299)
Can use of video Laryngoscopes by Emergency Medical Technicians Facilitate Endotracheal Intubation during Continuous Chest Compression? A Manikin Study
Authors: Han Sk , Choi Pc , Hong Ck , Shin Dh , Na Ju , Hwang Sy , Cho Jh 
Published: December 2017

Introduction We conducted this study to evaluate the utility of two video laryngoscopes (VLs) [Pentax-AWS (AWS), GlideScope (GVL)], compared to the conventional Macintosh laryngoscope (ML), on endotracheal intubation (ETI) involving chest compressions by Level 1 Korean emergency medical technicians (EMTs) who are the equivalent of EMT-I in the United States. Methods This was a randomised crossover simulation study. Fifty EMTs performed endotracheal intubation in randomised sequence following two different scenarios: normal airway and difficult airway. Results In normal airway scenario, overall success rate did not differ between the three devices. However AWS required a shorter run-time (14.1 [10.9-19.8] seconds) to complete ETI (TC) than ML (17.7 [13.5-21.3] seconds) (p=0.017). And both VLs showed a significant superiority over ML in time required to visualise vocal cords (TVC), percentage of glottic opening (POGO) score, and incidence of dental compression (IDC). In difficult airway scenario, overall success rate of both VLs was significantly higher than ML. The TC of AWS (13.7 [11.2-16.9] seconds) and GVL (20.7 [15.1-25.9] seconds) was shorter than that of ML (24.7 [18.1-34.5] seconds) (p<0.001). The TVC of GVL was significantly shorter than that of AWS and ML. The POGO score, IDC, and ease of intubation were significantly superior with AWS, GVL, and ML, respectively. Conclusions Video laryngoscopes can facilitate EMT performing a faster and easier intubation without interrupting chest compressions. Moreover, AWS improves the success rate comparing to ML in difficult airway management. (Hong Kong j.emerg.med. 2014;21:308-315)
CPR Knowledge and Attitudes among High School Students Aged 15-16 in Hong Kong
Authors: Ma Awwma , Wong Kl , Tou Ayl , Vyas L , Wilks J 
Published: December 2017

Background Sudden cardiac arrest is a serious public health problem in Hong Kong, with up to 85% of victims not surviving to hospital admission. International research findings show that teaching cardiopulmonary resuscitation (CPR) to lay bystanders can significantly improve out-of-hospital survival rates. A particular target group for CPR training and education is high school students. Since the commonest site of sudden cardiac deaths in Hong Kong occur at home, school-age adolescents are likely to be the only available bystanders in many emergent situations. Design Questionnaire survey. Methods This study investigated CPR knowledge and attitudes of 383 students aged 15-16 years across 18 schools in Hong Kong to understand barriers and facilitators for CPR delivery. A questionnaire pilot tested and validated by a panel of health professionals was distributed to students, using a convenience sampling methodology. Results Most students (87%) had not received CPR training, with common reasons for not attending being lack of time, lack of interest and not sure where to attend a course. Results of Mann Whitney U tests indicated that students who had received training scored significantly (p<0.05) higher on factual knowledge and also attitudes toward CPR training than those without training. There were no gender differences. Most students reported that they would attempt to perform CPR in a cardiac arrest situation, even if they had not received training, because they believed that CPR could increase the survival rate and it was morally the right thing to do. Conclusions Teaching CPR to Hong Kong school students is an effective way to develop the next generation of emergency first responders. (Hong Kong j.emerg.med. 2015;22:3-13)
Effective Healthcare Worker-Patient Communication in Hong Kong Accident and Emergency Departments
Authors: Slade D , Chandler E , Pun J , Lam M , Matthiessen Cmim , Williams G , Espindola E , Veloso Fod , Tsui Kl , Tang Syh , Tang Ks 
Published: December 2017

Introduction This paper reports on research conducted within a Hong Kong (HK) accident and emergency department (AED), which investigated the effectiveness of health care worker-patient communication over the course of patients' journeys from triage to disposition. Methods The research combined qualitative and quantitative ethnographic methods with linguistically-oriented discourse analysis of audiotaped interactions between patients and health care workers. It involved: (1) observations, (2) semi-structured interviews with management and health care workers, (3) surveys with AED staff, (4) audio-recordings of 10 patients' journeys, and (5) follow-up interviews with patients. Results The paper described the typically complex communication networks involved in AED care. It then exemplified how certain communicative strategies, balancing the communication of medical knowledge with interpersonal communication, could be used to achieve positive healthcare outcomes. This was illustrated by a case study of one patient's journey through the AED, pinpointing health care workers' effective use of communication strategies, their effect on the patient's participation and subsequently the patient's understanding and evaluation of the care he received. Conclusion The high stress nature of AEDs inevitably poses challenges to communication. The results of this study, however, strongly suggest a correlation between health care workers' use of effective, interpersonally sensitive communication strategies and positive patient outcomes. Health care worker-patient communication that effectively balances interpersonal communication with the communication of medical expertise is integral to ensuring patients' participation in, understanding of, and satisfaction with their healthcare. These communication strategies should be required components in health care worker communication training. (Hong Kong j.emerg.med. 2015;22:69-83)
Predictors of Revisit and Admission after Discharge from an Emergency Department in Acute Pyelonephritis
Authors: Kang C , Kim K , Lee Jh , Jo Yh , Park Jw , Lee Sh , Kim Yj , Rhee Je , Kim Dh 
Published: December 2017

Introduction The aim of this study is to construct clinical prediction models to predict emergency department (ED) return visit following initial discharge for acute pyelonephritis (APN) and the need for hospital re-admission upon ED return visits. Method A retrospective analysis included 1250 discharged women with APN. Independent risk factors for revisit and subsequent admission after revisit were determined by multivariate analysis, and a prediction model for revisit and subsequent admission after revisit was constructed. Results Independent risk factors for revisit were nausea (2 points), age ≥ 65 years (2 points), C-reactive protein >20 mg/dL (2 points), serum albumin <3.3 g/dL (3 points) and urine white blood cell count ≥ 30/high power field (2 points). Re-visit risk scores were categorised to five groups and the re-visit rate was 5.4%, 8.6%, 12.2%, 19.1% and 43.8%, respectively, showing an area under curve (AUC) of 0.62. Risk factors for subsequent admission after revisit were vomiting (1 point), hypertension (2 points), serum creatinine <1.5 mg/dL (2 points), C-reactive protein >20 mg/dL (2 points) and serum albumin <3.3 g/dL (4 points). The subsequent admission after revisit risk scores were classified to three groups and subsequent admission after revisit rate was 3.5%, 15.0%, and 38.2%, respectively. Conclusion The developed model can identify a group of patients at high risk for a return visit and for requiring subsequent hospital admission, and might be used to improve initial disposition decision and discharge instructions. (Hong Kong j.emerg. med. 2015;22:154-162)
How Accurate are Emergency Department Medical Staff in the Interpretation of Head Injury Related Computed Tomography?
Authors: Cheung LW , Shih YN , Leung CS , Lo WS , Leung M , Lit ACH 
Published: December 2017

IntroductionComputed tomography (CT) brain has become a popular modality to detect head injury related problems for patients seen at the Emergency Departments (ED) in Hong Kong. This study aims to assess the diagnostic accuracy of local ED medical staff in interpretation of head injury related CT and to assess the association between years of working experience of ED medical staff and the diagnostic accuracy of CT brain interpretation.MethodsThis is a retrospective cohort study reviewing all patients attending the ED of Princess Margaret Hospital in three years (from 2008 to 2010) with head injuries requiring CT brain during ED stay. The findings of CT brain by ED medical staff were compared with those by radiologists, the reference standard.ResultsA total of 1716 cases were assessed. The overall sensitivity and specificity for detecting an abnormal CT were 0.66 (95% confidence interval [CI] 0.60‐0.71) and 0.96 (95% CI 0.95‐0.97), respectively. The sensitivity showed an increasing trend from 0.63 (95% CI 0.54‐0.72) in ED staff with 0‐3 years of working experience, to 0.71 (95% CI 0.59‐0.84) with 4‐6 years of experience and 0.75 (95% CI 0.63‐0.86) with 7‐10 years of experience. It dropped to 0.59 (95% CI 0.47‐0.71) with more than 10 years of experience.ConclusionsThe head injury related CT interpretation skill by ED medical staff is suboptimal. More training is necessary. (Hong Kong j.emerg.med. 2015;22:241‐247)