bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can “Oral Fluid” be Used Instead of “Urine” for Rapid Screening of Drug of Abuse: A Prospective Pilot Study
Authors: Chow ATY , Ng VCH , Lau FL 
Published: December 2017

Introduction Spot urine tests are commonly employed by emergency physicians in Hong Kong to detect recent abusive drug exposure. Spot tests utilising oral fluid are gaining its popularity in other parts of the world. There was lack of evidence about employment of rapid oral fluid test (ROFT) in the local emergency medical settings. The objective of this study is to determine the operating characteristics of ROFT, and to compare its agreement with the bedside urine immunoassay test (BUIT). Setting The emergency department and the substance abuse clinic of a regional hospital. Methods This was a single-centered cross-sectional study of diagnostic test. Patients suspected to have drug abuse were tested using either one or both of the commercially available ROFT and BUIT. The sensitivity, specificity and accuracy of both tests were calculated with reference to the laboratory urine toxicology screening results. The agreement between ROFT and BUIT was calculated. Results For the detection of ketamine and methamphetamine (the two most prevalent abusive substances), ROFT had 72-100% sensitivity and 93-100% specificity, which were comparable to that of BUIT (74-100% sensitivity and 100% specificity). The overall observed agreement of ROFT and BUIT results was at least 96%. There was good agreement between ROFT and BUIT with kappa values of 0.90-1.00. Conclusion In this pilot study, the operating characteristics of ROFT are comparable with that of BUIT, with both tests showing good agreements in the detection of ketamine and methamphetamine uses. ROFT can potentially be employed as an alternative investigation for rapid diagnosis of patients with suspected drug abuse. (Hong Kong j.emerg.med. 2015;22:265-269)
Role of Sodium Bicarbonate in Resuscitation of out-of-Hospital Cardiac Arrest
Authors: Chung CW , Lui CT , Tsui KL 
Published: December 2017

Objective To report the use of sodium bicarbonate (SB) in out-of-hospital cardiac arrest (OHCA) and to explore the role of sodium bicarbonate in resuscitation of OHCA in terms of restoration of spontaneous circulation (ROSC) and survival, and existence of dose-dependent relationship, especially in those with prolonged arrest. Design Retrospective cohort study. Setting Emergency department of two regional hospitals in a cluster of Hong Kong. Methods Adult patients aged at least 18 years old who presented to the study centres with non-traumatic OHCA in the period between March 2013 and December 2013 were included. Cases in which resuscitations were considered medically futile or not actually performed were excluded. Those with do-not-resuscitate (DNR) order or advance directives, those who were death before arrival with postmortem changes, and those who developed ROSC before or within 15 minutes of arrival were excluded from the study. Patients with known poisoning from tricyclic antidepressant or other sodium channel blockers were excluded from analysis if any. The primary outcome of this study was ROSC. Other outcome variables included survival to hospital admission (STA) and survival to hospital discharge (STD). Results A total of 489 patients were included during the study period for analysis. We found that patients who received sodium bicarbonate injection (SB group) during CPR had a higher percentage of ROSC than those who did not (no-SB group) (60.8% vs 22.5%; p<0.001). The survival-to-admission rate was higher in the SB group (56.8%) compared with the contrary (21.4%). The difference of survival-to-discharge between the two groups did not reach statistical significance (4.1% in SB group and 2.9% in the no-SB group; p=0.484). The rate of ROSC was found to be dose dependent, being higher in higher dose of SB administration. The ROSC rate increased from no-SB (22.4%) to 57.1% if given 50 ml SB, and further to 64.1% if given ≥100 ml SB. Conclusions Our study shows that the use of sodium bicarbonate in the CPR of OHCA is beneficial in ROSC. The effect is dose dependent, with better results in higher dose (>100 ml) of sodium bicarbonate; however, we fail to demonstrate its benefit for prolonged CPR cases (>30 minutes). (Hong Kong j.emerg. med. 2015;22:281-290)
X-Ray and Ultrasonography in Forearm Trauma
Authors: Tandogan M , Katirci Y , Sonmez F Turan , Duymaz H , Altun S , Gunaydin YK , Coskun F 
Published: December 2017

Introduction This study aimed to prevent unnecessary exposure to ionising radiation, and to exclude non-fracture cases in children admitted to the emergency department with a forearm trauma, by showing that forearm trauma could be assessed with ultrasonography (USG) as accurately and precisely as with direct radiography. Methods A total of 105 patients (67 males and 38 females) were included in the study. Before performing radiography, the patients were assessed with USG and the results were recorded. The findings of USG and radiography were then compared. Results A total of 58 (55%) patients had fractures detected with USG. When compared to X-ray, the sensitivity of USG in detecting forearm fractures was 98.3% (95% confidence interval [CI]: 90.7-100%), specificity was 95.8% (95% CI: 86.0-98.9%), negative likelihood ratio was 0.018, positive likelihood ratio was 23.58, negative predictive value was 97.9% (95% CI: 88.7-99.9%), and positive predictive value was 96.6% (95% CI: 88.1-99.6%). Conclusion The use of USG on selected cases of paediatric patients may provide a more rapid evaluation so as to reduce exposure to ionising radiation. We believe that USG will be useful in excluding non-fracture cases. (Hong Kong j.emerg.med. 2015;22:352-358)
Canadian Computed Tomography Head Rule and Its Impact on Singaporean Practice
Authors: Pek JH , Wee JCP , Wong E 
Published: December 2017

Introduction We aim to determine the usefulness of the Canadian Computed Tomography (CT) Head Rule in patients who present with minor and minimal head injury to the emergency department. Methods Clinical information was retrospectively collected and the need for CT head was evaluated. The primary outcome measure was the requirement for neurological intervention. The secondary outcome measure was brain injury requiring admission or neurological follow-up. Results A total of 1127 cases were reviewed. About 6.3% had clinically important brain injury; and 1.2% required neurological intervention. The high-risk factors were 45.2% sensitive (95% confidence interval [CI]=27.8-63.7%) and 76.2% specific (95% CI=73.5-78.7%) for predicting need for neurological intervention. All seven risk factors were 73.2% sensitive (95% CI=61.2-82.7%) and 69.8% specific (95% CI=66.9-72.5%) for predicting clinically important brain injury. Overall, the rule had a positive predictive value of 14.0 (95% CI=10.7-18.1) and negative predictive value of 97.5 (95% CI=96.0-98.4). Conclusions In this retrospective validation of the Canadian CT Head Rule in the Singaporean context, we conclude that the lower sensitivity of the rule could be attributed to local neurosurgical practice, lack of application of the rule among clinicians and inclusion of patients with minimal head injury. Practically, the high NPV will mean that patients who do not fulfill the rule can be safely discharged with head injury advice, without the need for a scan. The judicious use of CT head can achieve savings for our health-care system. (Hong Kong j.emerg.med. 2015;22:359-363)
Hong Kong Poison Information Centre: Annual Report 2014
Authors: Chan YC , Tse ML , Lau FL 
Published: December 2017

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2014. Methods In 2014, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,609 poisoned cases were analyzed. There were 1,587 male patients (44.0%), 2,000 female patients (55.4%) and 22 sex unspecified patients (0.6%). Middle aged group (30-39 years) was the commonest and composed of about one-fifth (20.3%) of the poisoning cases while about two-third (66.2%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (42.2%), unintentional exposure (16.5%) and abusive substances use (12.9%). Excluding the common co-ingestant ethanol, five commonest types of poison exposed were benzodiazepine, paracetamol, zopiclone, Chinese herbal medicine and household products. Majority of the patients were managed with supportive measures, and 14.7% and 15.0% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 5.0% had major outcomes. Conclusions This 9th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j.emerg.med. 2015; 22:376-387)
Analysis of Road Traffic Injuries by Road User Type in Chongqing, China
Authors: Qiu J , Li Y , Jiang Z , Yuan D , Ll G , Li Y , Zhang L , Zhao X , Zhou J 
Published: December 2017

Objective Road traffic injuries are caused by many different factors. This study aimed to analyse road user type information in Chongqing, China in order to develop prevention strategies as well as treatment protocols. Methods Data from road traffic crashes from Chongqing, China were collected prospectively over a seven-year period (2000 to 2006). The data included the road user type, description of the injury, mortality and Abbreviated Injury Scale. Prevalence and cross-tabulations were included in the analysis. Results Forty-nine percent of deaths were pedestrians and 27.84% of deaths were drivers. Head injuries (26.49%) of pedestrians were higher than those of drivers and passengers. Thoracic injuries (22.78%) and spinal injuries (4.44%) of injured passengers were higher than those of drivers and pedestrians. There were significant differences in road user types in both injury severity and injury regions. Conclusions The distribution of road traffic injuries in Chongqing, China is different from that in developed countries and other developing countries. In managing traffic injuries, it is necessary to examine other regions besides the head according to the road user type, such as facial injuries of drivers and passengers, and chest and spinal injuries of passengers.
Psychometric Evaluation of Patient Satisfaction with a Fast Track Protocol Driven Service
Authors: Soong BCP , Fan KP , Ng HY 
Published: December 2017

IntroductionWe aimed to develop a questionnaire with psychometric evidence of reliability and validity to evaluate patient satisfaction with a Fast Track Protocol Driven Service, which was developed to shorten the waiting time and improve the outcome of selected groups of patients. Such patients were initially managed by well‐trained nurses according to defined protocols and backed up by experienced medical practitioners. We would like to evaluate their satisfaction because traditionally patients used to be managed by doctors.MethodsWe collected data from 199 subjects from July 2014 to February 2015 using a questionnaire consisting of 24 questions. The subjects were given the questionnaire after receiving treatment and they filled in the questionnaire on sole voluntary basis. These 24 items were subject to Principal Component Analysis. The number of components to be extracted depended on the Eigenvalue. We utilised Varimax rotation for further interpretation and determined which question belonged to which component. We then assessed the internal consistency of each component by calculating Cronbach's alpha. Finally we calculated the mean score for each subscale.ResultsThree components were extracted with good internal consistency, namely “Clinical care”, “Negligence” and “Comprehensiveness”. The mean score for the above components was 43.15, 11.27 and 9.62 respectively. They proved good patient satisfaction in all three aspects.ConclusionsWe have developed a questionnaire with reliability and validity for evaluation of patient satisfaction with our service. The data of our survey shows that our patients are satisfied in the three aspects namely “Clinical care”, “Negligence” and “Comprehensiveness” statistically. (Hong Kong j. emerg.med. 2016;23:12‐16)
Investigation of the Relation between Carbon Monoxide Exposure/Intoxication and Tobacco‐Free Narghile Products
Authors: Turedi S , Aksut N , Tatli O , Karaca Y , Turkmen S , Mentese A , Gunduz A 
Published: December 2017

ObjectivesUse of tobacco‐based narghiles may have potentially fatal consequences, such as carbon monoxide (CO) intoxication. However, there are only limited studies on the effects on human health and CO levels of tobacco‐free narghile products. The primary aim of this study was to investigate the effect of tobacco‐free narghile consumption on carboxyhemoglobin (COHb) levels and whether this would cause CO intoxication in active and passive narghile users.DesignObservational study.MethodsFour hundred ninety‐nine individuals exposed to tobacco‐free narghile smoke were divided into four groups; Group I: active narghile smokers, and non‐cigarette smokers, Group II: active narghile smokers and active cigarette smokers, Group III: passive narghile smokers and non‐cigarette smokers and Group IV: passive narghile smokers and active cigarette smokers. Fifty‐nine healthy volunteers were enrolled as control groups (Group V, non‐cigarette smoker controls, and Group VI, cigarette smoker controls). COHb levels were compared among the groups.ResultsMean pre‐exposure % COHb levels for groups I‐IV were 2.61± 1.46, 3.00±1.37, 2.09±1.45 and 3.00±2.13, and post‐exposure % COHb levels for groups were 3.45±1.92, 4.17±2.01, 2.60±1.66 and 4.50±2.32, respectively. Control groups (V‐VI) % COHb levels were 0.90±0.82 and 1.60±0.85, respectively. COHb levels rose significantly after exposure to tobacco‐free narghile smoke in all groups (p<0.001). COHb levels in all groups were higher than those in healthy individuals. Additionally, 12.8% of those exposed to tobacco‐free narghile smoke had toxic COHb levels.ConclusionThe use of tobacco‐free narghile products represents a potential danger, and COHb levels in active and passive smokers can reach intoxication levels. (Hong Kong j.emerg.med. 2016;23:17‐27)
Metronome vs. Popular Song: A Comparison of Long-Term Retention of Chest Compression Skills after Layperson Training for Cardiopulmonary Resuscitation
Authors: Hong CK , Hwang SY , Lee KY , Kim YS , Ha YR , Park SO 
Published: December 2017

Introduction Long-term retention of cardiopulmonary resuscitation (CPR) skill is challenging for layperson trainees. This study compared the long-term retention of chest compression skills after either metronome-guided (MG) or popular song-guided (PG) CPR training. Methods This was a prospective randomised simulation trial. Untrained laypersons were randomly allocated to MG (n=61) or PG (n=68) groups at CPR training sessions. After CPR training, each participant performed 5-cycle CPR using a manikin with a Skill-Reporter™ immediately and six months afterwards. Results Immediately after training, the mean compression rate (MCR) was slightly higher in the PG than the MG group (107.4 vs. 102.2/min; p<0.0001), but there was no significant difference in the proportions of participants with an appropriate chest compression rate (100-120/min) (PSACCR) between the MG and PG (53/61 (86.9%) vs. 65/68 (95.6%); p=0.114). Six months later, MCR was faster in the MG than the PG (124.8 vs. 110.0/min; p<0.0001), and PSACCR in the PG was higher than that in the MG (62/68 (91.2%) vs. 25/61 (41.0%); p<0.0001). In both tests, there were no significant differences in other chest compression parameters of between the two groups, except for a minimal difference in incomplete chest release. Conclusion CPR training using a popular song is more effective than metronome-guided training in helping laypersons to maintain recommended compression rates after 6 months. (Hong Kong j.emerg.med. 2016;23:145-152)
Evaluation of a Commercial Phantom and Pork Meat Model for Simulation Based Training of Ultrasound Guided Intravenous Catheterisation
Authors: Leung KY , Mok KL , Yuen CK , Wong YT , Kan PG 
Published: December 2017

Introduction Establishing intravenous access is a common procedure being performed in the emergency department. Ultrasound guidance is useful for difficult intravenous cannulation. We compared a commercially available Blue Phantom™ and a self-made pork meat model for suitability of simulation based training. Methods We recruited emergency physicians from two public regional hospitals in our locality. We also recruited Myanmar emergency physicians from an ultrasound course. They were given a 30-minute hands-on practice on both phantoms. Questionnaires, which asked about the practical feeling and overall impression of both phantoms, were distributed afterwards. Results Thirty-nine emergency physicians with varied experience in ultrasound guided intravenous catheterisation enrolled in the study. The median score were 4 (i.e. agree) in seven out of eight pairs of questions. The practical feeling and overall personal impression were very similar between Blue Phantom™ and pork meat model. Conclusions The suitability of self-made pork meat model was similar to Blue Phantom™ for the training of ultrasound guided IV catheterisation. Pork meat model can used as an alternative training tool. (Hong Kong j.emerg.med. 2016;23:153-158)
Diagnosing Epiglottitis with Radiographs: Can we be More Objective?
Authors: Wong YK , Pan NY , Chu CY , Chan TN 
Published: December 2017

Objective The classical radiographic signs in acute epiglottitis are qualitative. The purpose of our study was to identify objective radiographic parameters to aid diagnosis of acute epiglottitis in Chinese adults. Methods A case-control study of Chinese adult patients attending the accident and emergency department (AED) who were subsequently diagnosed to have acute epiglottitis from 1st January 2009 to 31st December 2013 in a public hospital in Hong Kong. Controls were one-to-one age- and sex-matched patients who attended the AED during the study period for orthopaedic problems with cervical spine radiographs taken. Cases and controls were retrieved from the hospital computer system and their radiographs were interpreted by two specialist radiologists with various pharyngeal and laryngeal parameters, including the dimensions of the third cervical vertebral body, epiglottis, aryepiglottic fold, hypopharynx, retropharyngeal soft tissue and retrotracheal soft tissue, measured and analysed. Sensitivity, specificity, positive and negative likelihood ratios were calculated for each of the parameters. Results Twenty-six patients and 26 age- and sex-matched controls were included in the study. Epiglottis width of 5.5 mm or more was found to be 96.2% sensitive and 100% specific in diagnosing acute epiglottitis. Positive and negative likelihood ratios were infinity and 0.04 respectively. Aryepiglottic fold width of 5.9 mm or more was 92.3% sensitive and 80.8% specific. Positive and negative likelihood ratios were 4.80 and 0.10 respectively. Conclusion The identified objective radiographic parameters should aid in the diagnosis of acute epiglottitis in Chinese adults. (Hong Kong j. emerg.med. 2016;23:168-175)
Diagnostic value of mean Platelet Volume for Chinese Patient with Acute Coronary Syndrome Presenting to an Emergency Department in Hong Kong
Authors: Lo CH , Ma HM 
Published: December 2017

ObjectiveTo determine the diagnostic value of mean platelet volume in local Chinese with acute coronary syndrome who attended emergency department in Hong Kong.Designcross sectional study.Settingemergency department of a local hospital.MethodsData of adult Chinese patients presented to a local emergency department (ED) with chest pain were retrieved from 1st October 2010 to 31st October 2010. Blood test for mean platelet volume (MPV) was drawn, and its relationship with development of acute coronary syndrome (ACS) was studied.Results429 patients were enrolled and 77 (17.9%) of them were diagnosed to have ACS. Non‐statistically significant trend of elevated MPV was observed in ACS group vs non ACS group (8.0±1.12 fL vs. 7.8±1.03 fL, p=0.06). Subgroup analysis was performed on patients presented within 4 hours of onset of chest pain. Both MPV and adjusted MPV were higher in ACS group (p<0.03, and p<0.01 respectively). Cut‐off 6.97 fL of adjusted MPV has the best performance, with 90.91% sensitivity and 22.86% specificity.ConclusionsAdjusted‐MPV is higher in ACS within 4 hour of presentation, but the discriminating power is not adequate. Further study is needed to validate the cut‐off level and its clinical applicability.
Comparison of Mortality among Severe Trauma Patients Treated in a Trauma Centre versus a Non-Trauma Centre
Authors: Lai CH , Lai CH , Chen KH , Wang CH , Hsiao CT , Hsiao KY 
Published: December 2017

Introduction In Taiwan, patients with major trauma are often sent to the closest non-trauma centre for initial resuscitation and transferred to distant trauma centres subsequently. This study aimed to evaluate the in-hospital mortality of severe trauma patients treated in a trauma centre versus in a non-trauma centre. Methods This prospective observational study reviewed 223 patients with major trauma (defined as Injury Severity Scale [ISS] score >15) who visited either a Level I trauma centre or a non-trauma centre from April 2013 to March 2014. Data of clinical status, trauma mechanisms, laboratory and radiology, interventions, and mortality/survival were evaluated. Logistic regression analysis was performed to assess effects of initial hospital treatment on mortality. Results A total of 158 major trauma patients were taken to the trauma centre hospital, and 65 patients were taken to the non-trauma centre. Age > 70 years (odds ratio [OR] 6.24, 95% confidence interval [CI] 1.01 to 38.62, compared to age ≤40 years), Glasgow Coma Scale [GCS] 3-8 (OR 19.00, 95% CI 2.30-157.01, compared to GCS 13-15), GCS 9-12 (OR 28.88, 95% CI 4.40-189.86, compared to GCS 13-15), ISS score >25 (OR 6.95, 95% CI 1.27-38.08) and taken to non-trauma centre initially (OR 30.90, 95% CI 5.00-191.27) were significantly associated with mortality. Conclusion Initial treatment of patients with major trauma in a non-trauma centre was associated with increased mortality compared to initial treatment in a trauma centre.