bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Weighty Issue: The Impact of Body Mass Index (BMI) in Asian Trauma Patients
Authors: Teo YX , Teo LT , Go KTS , Yeo YT , Vasu A , Chiu MT 
Published: December 2017

Background The controversy surrounding the impact of Body Mass Index (BMI) on the outcome of trauma patients has been widely studied in the West. However, no such studies have looked at an Asian trauma population. The aim of our study was to investigate the impact of BMI on mortality, morbidity, severity and pattern of injury in trauma patients of multicultural Singapore. Methods In this prospective study, we recruited all trauma patients admitted to Tan Tock Seng Hospital over a 13 month period. Both the international World Health Organization (WHO) and Asian modified classifications of BMI were used for the purpose of our study. Patient demographics, co-morbidities, mechanism of injury, injury severity score (ISS), body regions injured, morbidity and mortality were collected using inpatient medical records. Results 964 patients with a mean age of 50.5 years were recruited. Majority of injuries sustained were due to falls. There was no association between Asian BMI and ISS. Head, neck and cervical injuries occurred less commonly in the overweight and obese group, but BMI does not confer protection from truncal injury. BMI was not a significant risk factor for morbidity or mortality. Conclusion Being overweight does not appear to increase severity of injury in Asian trauma patients. BMI as an independent risk factor does not contribute to trauma mortality or morbidity. We conclude that BMI is not a significant contributing factor to adverse trauma outcomes in Asians.
Patients with Bacteraemia Discharged from the Department of Emergency Medicine: Distribution of Organisms and Associated Characteristics
Authors: Lehn A , Sowden D , Anstey C , Stephensen B , Newman H 
Published: December 2017

IntroductionAlthough blood cultures are commonly used to investigate febrile patients presenting to an emergency department, treatment decisions usually have to be made before the results are available.MethodsWe performed a retrospective analysis of consecutive patients presenting with community-acquired bacteraemia at the emergency department of Nambour Hospital, Queensland, Australia between 2000 and 2008. We determined their clinical characteristics, the distribution of organisms and also assessed patient characteristics associated with discharge from the emergency department.ResultsA total of 885 patients with 915 presentations of community-acquired bacteraemia were included. While having bacteraemia, 33 patients (3.6%) were discharged from the emergency department. Age, mode of presentation, altered mental state, presence of immunocompromise, presence of respiratory distress, C reactive protein, Charlson score, age score and estimated 10 years survival were significant factors discriminating the admitted from discharged patients. The most commonly found organism in blood cultures of discharged patients was Staphylococcus aureus (27.3%), whereas in admitted patients it was E. coli (27.7%). Methicillin-resistant Staphylococcus aureus accounted for 1.7% of cases of community-acquired bacteraemia.ConclusionsEmergency physicians only rarely discharge patients with community-acquired bacteraemia using current assessment tools and decision-making rules. However, they tend to discharge younger self-presenting patients with good baseline function.
A 4 Year Retrospective Analysis of Our Patients with Mushroom Poisoning
Authors: Koksal O , Armagan E , Inal T , Ayyildiz T , Oner N 
Published: December 2017

ObjectiveThis study presented the demographic, clinical and laboratory data for the patients who presented to our emergency department (ED) with mushroom poisoning.MethodsWe retrospectively examined the data for adult patients with mushroom poisoning that presented to the ED of Uludag University, Faculty of Medicine between 1 January 2007 and 31 December 2010.ResultsA total of 53 patients were enrolled in the study. The mean age was 46.58±15.47. 52.8% of the patients were female, while 47.2% were male. These patients were typically admitted in the autumn. The most commonly seen symptoms were gastrointestinal such as nausea and vomiting. The time to symptom onset was <6 hours for 30.2% of the patients and >6 hours in 69.8% of the patients. While 73.5% of the patients received gastric lavage, activated charcoal and intravenous fluid therapy, 15.1% received penicillin, N‐acetylcysteine and intravenous fluid therapy. For the remaining patients (11.4%) silibinin, dialysis and plasmapheresis were administered. While 35.8% of the patients were hospitalised, 64.2% were discharged from the ED. The median duration of stay in the ED was 6 hours (range: 1‐27 hours); the median duration of stay among inpatients was 6 days (range: 1‐36 days). Three of the hospitalised patients died, and two underwent hepatic transplantation.ConclusionsMushroom poisoning remains an important issue that is encountered in rural areas during the rainy autumn season in our region. The condition may be fatal, but can be prevented by early and appropriate treatment.
A Changing of the Abbreviated Injury Scale that Improves Accuracy and Simplifies Scoring
Authors: Wang MD , Cai WW , Qiu WS , Qiu F , Lv WS 
Published: December 2017

Objective We present here a changing of the abbreviated injury scale (AIS). It is called the changed injury severity score (CISS), and significantly outperforms the venerable but dated the injury severity score (ISS) and the new injury severity score (NISS) as a predictor of mortality. Methods The CISS is defined as a change of AIS values by raising each AIS severity score (1-6) by a power of 4.12 divided by 30.33 and then summing the three most severe (i.e. highest AIS) regardless of body regions. CISS values were calculated for every patient in two large independent data sets: 3455, 3900 patients treated during a five-year period at the class A grade III comprehensive hospitals in Affiliated Hospital of Hangzhou Normal University (Hangzhou) and Zhejiang Provincial People's Hospital (Zhejiang). The power of CISS to predict morality was then compared with previously calculated NISS values of the same group patients in the two hospitals. Results We found CISS was more accurate than NISS to predict the survival. The receiver operating characteristic (ROC) of NISS and CISS in Hangzhou were 0.919 and 0.937 respectively (p=0.026), whereas for Zhejiang were 0.917 and 0.940 respectively (p=0.022). Moreover, CISS provided a better fit throughout its entire range of prediction. Hosmer-Lemeshow (H-L) statistic for NISS and CISS in Hangzhou were 24.00 (p=0.002) and 19.38 (p=0.007), whereas in Zhejiang were 22.70 (p=0.001) and 18.43 (p=0.005) respectively. Conclusions CISS is a modified version of NISS/ISS with better statistical property and can be considered in trauma research.
Patient Perceptions of HIV Testing in a Non-Urban Emergency Department's Express Care
Authors: Minak J , Syverud SA , Dillingham RA , Dort KR , Gessner AE 
Published: December 2017

Introduction This study evaluated participants' acceptance of rapid Human Immunodeficiency Virus (HIV) testing in the express care of an emergency department (ED) located in a semi-rural, low HIV prevalence area. Methods This was a cross-sectional survey performed in an ED's express care that serves an area with an estimated HIV prevalence of <1%. The survey included 10 questions with answers recorded on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” Adult English speaking patients, ages 18 to 64 years, who provided consent, were included. Participants were offered a finger-stick rapid HIV screening test but testing was not required for participation. Results A total of 117 participants were enrolled with 71 tested for HIV with no positive results. Participants demonstrated a preference for testing at a PCP's office, although testing in the ED was acceptable to them. They denied negative emotional response about an offer of HIV testing in the ED and did not desire more information about HIV or testing. Conclusions Despite the low prevalence and semi-rural study area, participants were receptive to HIV testing in the ED.
The Association between Facial Fracture Patterns and Traumatic Head Injury in Injured Motorcycle Riders According to Helmet Use Status
Authors: Kong DY , Kim HJ , Kang TK , Oh SC , Cho SJ , Choi SW , Ryu SY 
Published: December 2017

ObjectiveThis study was undertaken to identify the association between facial fracture patterns and traumatic head injury in injured motorcycle riders.MethodsRetrospective study design. We reviewed the medical records of patients who underwent facial bone computed tomography (CT) and brain CT simultaneously among the injured motorcycle riders between May 2009 and July 2011. Data collected included age, sex, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), facial fracture patterns, head protective device (helmet) use, alcohol intake, time of accident and seat position. Facial fracture patterns were grouped as upper, mid, and lower face. Traumatic head injury (THI) included skull fracture, brain haemorrhage and diffuse axonal injury.ResultsOf the 154 patients included, 138 (89.6%) were male, 57 (37%) had facial fracture, 69 (44.8%) wore helmets and 30 (19.5%) had THI. Their mean age was 29.0+15.0 years. After multivariate logistic regression analysis, THI was associated with GCS, seat position of riders and accident time. THI was correlated with the combination of upper and midfacial fractures in helmeted group and isolated upper facial fracture or the combination of upper and midfacial fractures in unhelmeted group. The rest of facial fracture patterns were not correlated with THI regardless of helmet.ConclusionsThe combination of upper and midfacial fractures are the risk factor of THI regardless of helmet. The patients with the combination of upper and midfacial fractures should be further evaluated for head injury regardless of helmet.
The Role of Oxidative Status in Initial Evaluation of Paediatric Patients with Graded Traumatic Brain Injury
Authors: Kaya H , Sogüt O , Gokdemir MT , Albayrak L , Taskιn A 
Published: December 2017

IntroductionThe purposes of this study were (a) to investigate the oxidative and antioxidative status in paediatric patients with varying severity of traumatic brain injury (TBI) during the early post‐traumatic period; (b) to correlate injury severity with the oxidative and antioxidative status of patients; and (c) to identify early predictors of outcome in patients with TBI.MethodsFifty‐two consecutive paediatric patients with isolated TBI and 31 age‐ and sex‐matched healthy controls were enrolled. Patients were divided into two groups based on their Glasgow Coma Scale (GCS) scores recorded upon admission to the emergency department within the first 24 hours after injury. Twenty‐three patients with moderate to severe TBI and 29 patients with mild TBI (GCS scores of >13) were included. The primary outcome variable was hospital mortality. Plasma total oxidant status (TOS), total antioxidant status (TAS), and the oxidative stress index (OSI) were assessed as predictors of early oxidative changes in serum using a novel automated measurement method.ResultsCompared to patients with mild TBI, TOS and OSI values were markedly elevated in patients with moderate to severe TBI. However, TAS levels did not show significant changes in either group of patients. Both GCS scores and Revised Trauma Scores were negatively correlated with the TOS and OSI, but neither was significantly correlated with the TAS. The TOS and OSI were significantly higher in non‐survivors than in survivors. However, there was no significant difference in TAS levels between survivors and non‐survivors.ConclusionPaediatric patients with isolated TBI are exposed to extensive oxidative stress, which varies with injury severity.
Who are Prone to Develop Adverse Effects with Oral Tramadol? a Retrospective Cohort Study
Authors: Li TY , Li YK , Chan CM 
Published: December 2017

Objective Oral tramadol is a commonly prescribed analgesic in Hong Kong. Significant adverse effects are frequently observed in our locality. Our study aims to describe the rate of significant adverse effect that warrant discontinuation of oral tramadol and identify the risk factors for development of adverse effect. Design Retrospective cohort study. Methods Adult patients aged greater than 18 years old admitted to the emergency medicine ward of a large-scale local hospital in Hong Kong being prescribed with oral tramadol during in-hospital stay were recruited. Significant adverse effects during the hospital stay were observed as the outcome of interest. Results A total of 575 subjects were recruited. 29.9% experienced significant adverse effects likely related to tramadol. Age (p=0.006; odds ratio [OR] = 1.017, 95% confidence interval [CI] = 1.005-1.029) and sex (p=0.006; OR=1.696, 95% CI= 1.166-2.465) were statistically significant predictors of adverse effects after oral tramadol. Conclusion Our study suggests that female and increasing age patients are significant predictors for the development of adverse effect after taking oral tramadol. Possible adverse effects should be explained to the patients careful especially the higher risk groups. (Hong Kong j. emerg.med. 2014;21:3-9)
Altered Mental Status in Emergency Department Patients with Cancer
Authors: Yaka E , Kaya S , Pekdemir M , Yilmaz S , Uygun K , Kama A 
Published: December 2017

Introduction Although cancer patients with acute altered mental status (AMS) often present to the emergency department (ED), there is lack of documentation for survival in ED cancer patients with related causes of AMS (structural or metabolic causes). The aim of this study was to evaluate reasons for acute AMS of cancer patients in the ED and their prognostic value for survival. Methods Medical records of cancer patients presenting to ED with acute AMS were reviewed. Patients were divided into 3 groups with respect to AMS etiologies: metabolic causes (Group 1), structural causes (Group 2) and both (Group 3). Median survival time was calculated from the ED presentation and Kaplan-Meier survival curve was generated to demonstrate survival in the three groups. Results Forty-nine patients had only metabolic causes of AMS (Group 1), 21 of whom had more than one metabolic abnormality. Forty-six patients had only structural causes (Group 2) and 7 had both metabolic and structural causes (Group 3). Survival probability at one month was 33% for all patients, 25% for Group 1, 48% for Group 2 and 0% for Group 3 (p=0.11). In Group 1, 32% of patients with only one metabolic disorder and 14% of those with more than one metabolic disorder were alive at one month (p=0.197). Conclusions Regardless of aetiology, cancer patients presented with AMS to the ED usually have poor outcomes. Survival in our ED cancer patients with AMS is not related to the either structural or metabolic causes of AMS. (Hong Kong j.emerg.med. 2014;21:10-15)
A 2-Hour Accelerated Chest Pain Protocol to Assess Patients with Chest Pain Symptoms in an Accident and Emergency Department in Hong Kong
Authors: Ko HF , Lee HY , Ho HF 
Published: December 2017

BackgroundThe present study is a follow up analysis of ASPECT study. We aimed to prospectively validate a 2-hour accelerated chest pain protocol (ACPP) to assess patients presenting to emergency department with chest pain symptoms suggestive of acute coronary syndrome.MethodsThis observational study was carried out between June 2009 and July 2010. Patients were included if they were older than 18 years old and presented with at least 5 minutes duration of chest pain. The ACPP included modified Thrombolysis in Myocardial Infarction score, electrocardiograph and point-of-care troponin I at presentation and 2-hour after. Primary endpoint was major adverse cardiac event (MACE) at 45-day of initial hospital attendance.ResultsA total of 384 Chinese patients were recruited and completed 45-day follow up. Forty-five (11.7%) had 45-d MACE. The ACPP identified 124 (32.3%) low risk patients who could be discharged early. No MACE occurred within 45 days among these patients, giving a sensitivity of 100% (95% CI 90-100), a negative predictive value of 100% (96-100), and a specificity of 36.6% (31.5-42).ConclusionsThe ACPP is able to identify very low risk chest pain patients who might be suitable for early discharge without increasing risk of developing MACE. The observation period can be shortened to 2-hour of ED presentation. The variables are objective and easily available. This 2-hour Hong Kong Chest Pain Rule is applicable to Chinese population and has the potential to change the current practice in Emergency Departments in Hong Kong and China. (Hong Kong j.emerg.med. 2013;20: 261-269)
Undetectable Troponin I at Presentation Using a Contemporary Assay does not Rule Out Myocardial Infarction
Authors: Kelly AM 
Published: December 2017

Objective Chest pain is a common reason for presentation to emergency departments (ED). Recent evidence suggests that an undetectable troponin level at ED presentation can rule out the presence of myocardial infarction (MI). The aim of this study was to externally validate that finding using a troponin I (TnI) assay. Methods Unplanned sub-study of a prospective observational cohort study of patients presenting to ED with chest pain without electrocardiogram evidence of ischaemia who underwent a ‘rule out’ acute coronary syndrome process. Clinical, investigational and outcome data were collected. Primary outcome of interest was diagnostic accuracy for type I MI at index visit. Results 685 patients were studied; median age 62, 60% male. Two hundred and seventeen had an undetectable TnI at ED presentation. There were two non-ST elevation myocardial infarctions in the group (2/217, 0.9%, 95% CI 0.16-3.6%). Sensitivity of undetectable TnI for ruling out type I MI was 98. 2% (99% CI 92.9-99.7%) with negative predictive value of 99.1% (96.4-99.8%). Conclusion Approximately 1% of patients with an undetectable TnI at ED presentation were diagnosed with a type I MI. An undetectable initial TnI using a contemporary sensitive TnI assay does not safely exclude MI in an ED chest pain cohort. (Hong Kong j.emerg.med. 2014;21:31-36)
The Attitude of the Medical Students of the University of Hong Kong towards Emergency Medicine
Authors: Leung LP , Wong TW , Tong HK 
Published: December 2017

IntroductionUnderstanding how medical students view the Specialty of Emergency Medicine is important. The knowledge helps the leaders in Emergency Medicine better plan the development of the specialty. In the medical literature, few studies primarily investigated this subject. Most were on the career choice of medical students. This study aimed at addressing this knowledge gap.MethodsIt was a cross‐sectional questionnaire survey of the year 3 to 5 medical students studying at the Li Ka Shing Faculty of Medicine, the University of Hong Kong. The questionnaire measuring their attitude consisted of 16 items in 3 domains: overall merits of Emergency Medicine, the role and function of emergency physicians and the career prospect in Emergency Medicine. Descriptive statistics were used for data analysis. Their attitude was represented by an attitude score with 80 being most positive and 16 most negative.ResultsA total of 298 students participated in the survey. The response rate was 64.5%. The overall median attitude score was 59. Year 5 students had a statistically significant higher score. Emergency Medicine ranked third in their first specialty choice after qualification. There was no statistical relationship between a student's attitude score and the specialty choice.ConclusionThe students' overall attitude towards Emergency Medicine was positive. Senior students held a more positive attitude. A student's specialty choice after qualification did not seem to relate to their attitude towards the specialty. (Hong Kong j.emerg.med. 2014;21:67‐72)
From ICU to Emergency Department: 9-Year Experience with Non-Invasive Ventilation for COPD
Authors: Ibrahim I , Phua J , Goh EL , Mahadevan M , Lim TK 
Published: December 2017

Introduction Non-invasive ventilation (NIV) has been shown to be beneficial for chronic obstructive pulmonary disease (COPD) patients with persistent respiratory acidosis during acute exacerbations. This clinical study described the experience of implementing an NIV program in the emergency department for COPD patients. Methods In the pre-implementation phase, patients who presented to the emergency department were transferred to the intensive care unit for NIV. Following the NIV program, patients had NIV commenced in the emergency department. We reported the change in hospital outcomes pre and post-implementation. Results A total of 153 patients received NIV, 34 in the pre-implementation phase and 119 patients in the post-implementation phase. The mean pH was 7.22±0.07 and the Acute Physiology and Chronic Health Evaluation (APACHE) II score was 18.9±4. Hospital mortality was lower in the post-implementation phase (1.7% versus 11.8%; p=0.008). The median door-to-NIV time was shorter in the post-implementation phase (64 minutes; interquartile range [IQR] 35-113) versus (457 minutes; IQR 143-1320). Conclusions NIV program in the emergency department is feasible and is associated with better hospital outcomes in patients with COPD. (Hong Kong j.emerg.med. 2014;21:140-147)
A Pilot Study on the Repair of Contaminated Traumatic Wounds in the Emergency Department Using Sterile versus Non-Sterile Gloves
Authors: Ghafouri HB , Zoofaghari SJ , Kasnavieh MH , Ramim T , Modirian E 
Published: December 2017

Background Although the use of sterile gloves for minor and major surgical repairs is the current standard of care, use of non-sterile and clean gloves has been shown to be safe in certain procedures. In this study, we compared the infection rates of contaminated lacerations repaired with sterile versus non-sterile gloves. Materials and methods A prospective, randomised, two-centre pilot trial included patients that attended the emergency department with any type of visible contaminated soft tissue lacerations. The patients were selected according to convenience sampling technique and divided into two groups using random number table. Age, sex, and characteristics of the wound were assessed by a physician. According to that, the physician used sterile gloves or non-sterile, clean gloves for wound repair. Clinical data were analysed by chi-square test and paired-t test where appropriate. A p value =/< 0.05 was considered as statistically significant. Results Two hundred and twenty two recruited subjects with visible contaminated simple wounds were randomised to 2 groups. Males constituted 89.2% of the patients. The sites of lacerations were extremities in 50.5% of patients, head or neck in 48.4% of patients, and trunk in 1.1% of patients. Overall infection rate was 3.2%. The infection rates in the sterile gloves group and the clean gloves group were 2.02% and 4.6%, respectively (relative risk=2; odds ratio=2.3). Incidence of infection was not significantly different between two groups (p=0.322). Conclusion It seems that uses of clean gloves rather than sterile gloves do not increase the risk of infection in the repair of contaminated simple wounds in emergency department setting. (Hong Kong j. emerg.med. 2014;21:148-152)