bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Regional Study on Primary Trauma Diversion in Hong Kong
Authors: Suen KW , Chang AML , Au CKH 
Published: December 2017

BackgroundPrimary trauma diversion (PTD) allows ambulance crews to transport severely injured patients directly to trauma centres. It has been launched in Kowloon Central Cluster (KCC) of Hospital Authority, Hong Kong since 2006.ObjectiveThe study investigated the performance of PTD with a view to provide relevant information for further development. The compliance with PTD, under‐triage and over‐triage were the major outcomes measurement. Patients' characteristics and their clinical information were also described.MethodThis was a retrospective descriptive study. We reviewed and analyzed the data in our hospital trauma registry during the study period between 1st July 2006 and 30th June 2009.ResultOne hundred and sixty‐three trauma patients were diverted to our trauma centre during the study period. The mean Injury Severity Score was 11.72 with 90 of them being classified as severely injured. We found that 47 and 73 patients were under and over triage respectively. About 74% eligible trauma patients were diverted to the trauma centre according to PTD criteria.ConclusionAlthough the initial experience of PTD in KCC is satisfactory, more severely injured patients will benefit from our trauma centre service by improving the under‐triage rate. We also foresee a better compliance with trauma diversion in the future.
Pain Perception in Emergency Department Patients with and without Headache
Authors: Yuruktumen A , Karaduman S , Yesilaras M , Guryay M , Fowler JR 
Published: December 2017

ObjectivesAdequate pain management of emergency department (ED) patients is an important clinical goal. Pain perception in ED patients with headache has been reported to differ from that of other patients with pain. If this were true in our setting, we might interpret pain scores and response to analgesics differently. We compared pain perception in ED patients without pain, patients with headache, and patients with non-headache pain who had blood pressure (BP) measurement and intravenous (IV) cannulation for any reason.MethodsThe study design was approved by our hospital's Ethics Committee. The patients were asked to describe their pain while undergoing BP measurement and IV cannulation with a 0 through 10 (11-point) numerical rating scale. Pain scores were analysed according to the patient's group: no pain, headache pain, or non-headache pain.ResultsFor the 278 participating patients (95 patients without pain, 77 patients with headache, and 106 patients with non-headache pain), the pain scores as reported during BP measurement and IV cannulation was not significantly different between the patient groups. On sub-group analysis, females reported higher pain scores during IV cannulation than males (2.8±2.6 vs. 2.3±1.9, p=0.06). In addition, married patients had higher pain scores than unmarried patients during both BP measurement (1.31 vs. 1.03, p=0.004) and cannulation (2.73 vs. 2.16, p=0.089).ConclusionThe differences in pain experienced in patients with or without headache or other causes of pain during IV cannulation and BP measurement were minor. Based on our findings, gender and marital status should be recorded during studies recording pain levels in ED patients.
The Prognostic Values of the Admission Electrocardiography, Myocardial Injury Markers and Physical Examination in Patients with Acute Myocardial Infarction
Authors: Ertan C , Cete Y , Kilicaslan I , Goksu E , Kanalici H 
Published: December 2017

Introduction Acute coronary syndromes (ACS) are leading life threatening causes of chest pain, which is one of the most common complaints in the emergency department (ED). The aim of the study was to demonstrate the usefulness of physical examination, ECG and cardiac markers to predict short term outcome of ACS patients. Methods A total of 1728 patients with chest pain were evaluated between 1st January 2003 and 31st December 2003 in the ED and 236 of the patients matched our study criteria. Results In the study group 184 patients were (78%) male and the mean age was 59.8±12.2 (range=4-92) years old. Age, Killip score, cardiac marker values, the time interval between the beginning of the chest pain and ED entry and the ECG changes were the studied variables. With the logistic regression analysis, Killip score and any rhythm other than normal sinus rhythm on the first ECG were found to be the only independent variables to predict early mortality (p=0.036 and p=0.033). Conclusion Simple measures in the ED such as ECG and serum markers of myocardial injury along with the thorough physical evaluation of the physician may predict early negative outcome.
Prospective Observational Study on Heart Rate Variability in Emergency Department Patients with Sepsis
Authors: Wong WCL , Lit ACH 
Published: December 2017

Objective To study the predictive value of heart rate variability in septic patients presented to the emergency department. Design Cross sectional study. Setting Emergency department. Methods Septic patients in the emergency department were recruited according to criteria. Heart rate variability data on time domain and frequency domain were generated from Holter records. Sequential Organ Failure Assessment, clinical progress and laboratory values were used to access the outcomes. Results Spectral power of total power (TP), low frequency (LF), very low frequency (VLF) and normalised low frequency (nLF) are shown to be significantly reduced in patients with sepsis who deteriorated (p=0.0070, 0.0032, 0.0005 and 0.0109 respectively). Cut off value 172.5 of VLF can identify all septic patients with potential deterioration. Conclusions Application of heart rate variability recording in emergency department is feasible and helpful in early identification of potentially deteriorating septic patients.
Severe Blunt Perineal Trauma in Children: A Retrospective Analysis of 28 Patients
Authors: Sogut O , Boleken ME , Cevik M , Yavuz G 
Published: December 2017

PurposeThe current study was designed to determine the common mechanisms of blunt perineal trauma (BPI) and associated injuries in paediatric patient. The initial management and outcome concerning such injuries are discussed.Materials and methodsThe hospital records of 28 paediatric patients who were treated surgically between April 2004 and November 2010 because of BPI were reviewed retrospectively. The initial clinical examination under conscious sedation (EUCS) in each patient was performed by both an experienced emergency physician and a paediatric surgeon to obtain a complete physical examination.ResultsAmong the 28 paediatric patients, twenty-two girls and six boys, aged 2 to 12 years experienced BPI. Fall onto a rough surface was the main cause for BPI in 21 patients (75%) and the rest had a motor vehicle-pedestrian crash. Five patients had concomitant anal or rectal injuries. There were concomitant urinary tract injuries in eight patients of whom three had combined lacerations or contusions of the perineum and disruption of the posterior urethra. There was concomitant complete rupture of proximal urethra from bladder in one patient. The remaining 4 patients with urinary tract injuries suffered from periurethral lacerations. The fifteen patients without anorectal or urethral injuries had concomitant vaginal or vulvar lacerations.ConclusionAll paediatric patients who sustained severe BPI should be checked for multi-system trauma and those undergone routine EUCS to evaluate the extent of concomitant injuries should pay particular attention to the anorectal and urogenital tracts. Primary repair of such injuries is often recommended as the initial treatment of choice.
Acute Brown-Séquard Syndrome following Brachial Plexus Avulsion Injury. A Report of Two Cases
Authors: Zubair M , Ravindran T , Chan CYW , Saw LB , Kwan MK 
Published: December 2017

Introduction Brown-Séquard syndrome is an unusual sequelae of pre-ganglionic brachial plexus injury. There have been sporadic case reports indicating that the cause of this condition is due to tethering of the cord, vascular ischaemia or direct avulsion injury of the nerve roots. This is a report of two patients with complete pre-ganglionic brachial plexus avulsion injuries who developed acute partial Brown-Séquard syndrome due to haematoma. Cases Two patients developed acute partial Brown-Séquard syndrome associated with complete pre-ganglionic brachial plexus avulsion injuries. In the first case the neurology recovered fully after the evacuation of the large subdural hematoma. Whereas, in the second case the neurology only recovered after 4 weeks closed observation in view of the compression was due to small epidural haematoma. Conclusion Acute Brown-Séquard syndrome occurring in association brachial plexus injury should be investigated with urgent magnetic resonance imaging to exclude any reversible haematoma compression.
Care and Charges for Acute Cerebral Infarction Inpatients in China: A Hospital Based Study in Soochow
Authors: Wen ZM , Zhao HQ , Liu CF 
Published: December 2017

Objective The objective of the present study is to evaluate the current status of care and charges of acute ischaemic stroke in a university teaching hospital in China, and to identify the main determinants of such charges. Methods Acute ischaemic stroke patients from July 2009 to June 2010 were considered. We examined demographic data, clinical data, hospital care and outcomes at discharge and hospital charges retrospectively. The influence of medical factors on total charges was analyzed. Results The mean initial National Institutes of Health Stroke Scale score of all acute ischaemic stroke patients was 7.2 points. Thirteen percents were total anterior circulation syndrome, 20% were partial anterior circulation syndrome, 7% were posterior circulation syndrome and 60% were lacunar syndrome. The mean hospital length of stay (LOS) was 8.5 days. All patients underwent neuroimaging studies, 2% of whom received thrombolysis, 93% received traditional Chinese medicine injection, 83% received antiplatelet and 6% received anticoagulation therapy, only 29% received in-hospital rehabilitation. The mean hospital charges per patient was ¥9230.2 (US$1357.3), of which 56.2% was attributed to the charges for medications, 13.4% for imaging studies, 12.1% for laboratory examinations. Total hospital charges were correlated strongly with LOS, admission to care unit, and computed tomography angiography or digital subtraction angiography of the brain. Conclusions Total hospital charges correlates significantly with hospital LOS, admission to care unit, investigation with computed tomography angiography or digital subtraction angiography of the brain, while clinical syndromes do not influence total charges independently. The cost of drug is the largest portion of the mean hospital charge. A treatment protocol in acute ischaemic stroke might optimise cost. (Hong Kong j.emerg.med. 2011;18:383-390)
Use of Typical Antipsychotics Predicts Recurrent Hypothermia for Institutionalised Psychiatric Patients
Authors: Li KY , Lui CT , Tsui KL 
Published: December 2017

ObjectiveTo find out the predicting factors of early recurrent hypothermia in patients from a mental institute and the role of use of antipsychotics.DesignRetrospective cohort study.SettingAccident and emergency department of a regional public hospital in Hong Kong.MethodAll adult patients transferred from a mental hospital to the study centre presenting with hypothermia from 1st January 2002 to 31st December 2009 were included. Demographic data, medical history, drug history, patient's mobility status, and the ambient temperature of the presenting date were collected as predicting variable and analyzed using Wei, Lin and Weissfeld model, with time to the next hypothermia as outcome variable.ResultsForty eight patients with 96 hypothermia episodes were included. The use of typical antipsychotics was associated with a significantly shorter median time to the next hypothermia episode (50.2 to 21 months) (p=0.005 by log rank test). In the Wei, Lin and Weissfeld model, use of typical antipsychotics was the sole significant predicting factor for early recurrent hypothermia (p<0.0001), with hazard ratio of 2.89 (95% CI 1.64‐5.10).ConclusionUse of typical antipsychotics is the only significant predictor of early recurrence of hypothermia in institutionalised psychiatric patients.
Comparison of the Analgesic Effect of an Ice Cube versus 4% Lidocaine Cream in Intradermal Antibiotic Skin Testing
Authors: Shin HJ , Park JM , Kim KH , Shin DW , Park JS , Roh JY , Kim H 
Published: December 2017

ObjectiveThis study was performed to compare the analgesic effect of an ice cube with that of 4% lidocaine cream (L.M.X.4®) for intradermal skin testing.MethodsIn this prospective randomised study, healthy adult volunteers were divided into ice cube and lidocaine analgesic pretreatment groups. Randomisation was performed using a randomisation table in blocks of four. Intradermal skin testing was performed after applying ice in the ice cube group and 5 mg of lidocaine cream in the lidocaine group. After the intradermal skin test, the pain intensity was investigated using the visual analog scale (VAS) on questionnaires. We calculated that a minimum of 24 subjects were required for statistical power of 80% at a significance level of 0.05 (two-sided). The groups' VAS scores were compared using the Mann-Whitney U-test.ResultsThe study population consisted of 35 volunteers: 17 in the ice cube group and 18 in the lidocaine group. There were no differences in demographic characteristics between the two groups. The median VAS score was 20 (interquartile range: 0-35) in the ice cube group and 70 (interquartile range: 50-80) in the lidocaine group (p<0.001).ConclusionsThe results suggested the utility of an ice cube as analgesic pretreatment for intradermal skin testing in the emergency department.
Is Poisoning by Oral Therapeutic Drugs more Severe? a Retrospective Study on Unintentional Paediatric Poisoning in a Local Emergency Hospital
Authors: Li KY , Lam SK , Lui CT , Fung HT 
Published: December 2017

IntroductionPaediatric unintentional poisoning is a common presenting problem in the emergency department. Our study aim to determine whether poisoning caused by oral therapeutic drugs was more severe and causing longer hospital stay. We also aim to review the recent local epidemiology of unintentional paediatric poisoning in Hong Kong.MethodsWe conducted a retrospective review on all consecutive cases of patients aged 0-9 who presented to the emergency department during a study period from 1st January 2006 to 31st December 2007 with unintentional poisoning. Demographic data, clinical presentation, poisoning agent involved, intervention performed and the clinical outcome were analysed. The clinical outcomes of poisoning due to oral therapeutic drugs versus other chemicals were compared.ResultsSixty one poisoning episodes were included. The most common type of agents involved was oral therapeutic drugs (52.5%); followed by cleaning products and detergents (14.8%). Most cases were benign, 63.9% of the cases showed no clinical and biochemical poisoning effect without any treatment. Poisoning due to oral therapeutic drugs were more severe, 12.5% were classified as poisoning with major effect that required active treatment while no cases of severe poisoning were found in poisoning caused by other chemicals. Significantly fewer cases (40.6%) were classified as no or mild effect in the group caused by oral drugs, compared with those caused by other chemicals (86.2%) (p=0.001). The mean length of stay was also significantly longer in the group with oral drugs (1.7 days) compared with 0.9 days in other chemicals (p=0.047).ConclusionsIn our locality, severe unintentional poisonings were usually due to oral therapeutic drugs. For prevention planning, we should focus on the safety placement of oral medications of family members.
Predictors of Mortality in Septic Shock: Findings for 57 Patients Diagnosed on Admission to Emergency or within 24 hours of Admission to Intensive Care
Authors: Yücel N , Togal T , Gedik E , Ertan C , Kayabas U , Akgün FS , Bayindir Y 
Published: December 2017

Objective To identify the risk factors that influence outcome for patients who are diagnosed with septic shock in the emergency department at presentation or within 24 hours after admission to intensive care unit. Methods A retrospective study of 57 adult patients with septic shock was conducted between March 1, 2006 and August 31, 2009. Results The patients were 23 males and 34 females with a median age of 67 years (20 to 92 years). Thirty-three (58%) of 57 patients died in hospital and 24 (42%) survived. Multivariate analysis identified low blood pH (OR <0.001; 95% CI <0.001-0.53) and low bicarbonate level (OR 0.81; 95% CI 0.70-0.95) at emergency department or intensive care unit admission as useful predictors of 3-day in-hospital mortality. Low blood pH (OR <0.001; 95% CI <0.001-0.05), low bicarbonate level (OR 0.75; 95% CIs 0.61-0.91), long duration of symptoms (OR 1.49; 95% CI 1.04-2.13), high MEDS score (OR 1.56; 95% CIs 1.06-2.30), and high SOFA score (OR 1.57; 95% CI 1.12-2.20) were risk factors for 14-day in-hospital mortality. Renal failure (OR 7.58; 95% CI 1.28-44.77), lower pulmonary tract infection (OR 3.58; 95% CI 1.10-11.58), high MEDS score (OR 1.42; 95% CI 1.05-1.93) and high APACHE II score (OR 1.34; 95% CI 1.13-1.60) were risk factors for 28-day in-hospital mortality. Conclusions Several factors signaling poor short-term outcome for this patient group are low blood pH, low serum bicarbonate level, longer duration of symptoms, lower respiratory tract infection and renal failure. MEDS and SOFA scores might be helpful in the ED to stratify patients with septic shock according to mortality risk.
Hong Kong Poison Information Centre: Annual Report 2011
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 2011. Methods In 2011, all poisoning cases received by HKPIC were retrieved from its database: Poison Information and Clinical Management System (PICMS) for analysis. Results A total of 4,331 poisoned cases were analysed. There were 1,915 male patients (44.2%), 2,411 female patients (55.7%) and 5 patients with sex unknown. More than two-third (68%) of them were between 20 and 59 years old. Common causes of exposure were suspected self-harm/suicidal attempt, unintentional exposure and abusive use. Paracetamol, benzodiazepine, household product, zopiclone, and Chinese herbal medicine were the top five commonest poisons encountered. Majority of the patients were managed supportively, with 12.1% and 8.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 4.8% of the exposure had major outcomes. Conclusions This 6th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.
Children's Discomfort during Noninvasive Cardiac Output Monitoring by Suprasternal Ultrasonographic Transducer
Authors: Chan SSW , Cattermole GN , Leung MPY , Ho GYL , Graham CA , Rainer TH 
Published: December 2017

ObjectivesTo investigate the level of discomfort/pain in children receiving Ultrasonic Cardiac Output Monitoring (USCOM), as compared to blood pressure measurement.MethodsHealthy children, aged 3‐12 years old, were recruited from kindergartens and schools as a part of the “Healthy children's vital signs and USCOM values” project. Oscillometric blood pressure was measured, followed by USCOM measurement. The discomfort experienced by the child during each intervention was assessed using the Wong‐Baker FACES pain rating scale. The pain scores (scale from 0‐5) were compared using Wilcoxon signed rank test. A difference in score of one point was considered to be clinically relevant. Gender differences in pain score were analysed using Mann‐Whitney‐U test.ResultsA total of 254 subjects (131 boys, 123 girls) were included. Mean age was 7.9 years with standard deviation (SD) of 2.4 years. The median pain score for USCOM measurement was 1.0 (95% CI=1.0 to 2.0) with interquartile range 1.0 to 2.0. The median pain score for BP measurement was 1.0 (95% CI,=1.0 to 1.0) with interquartile range 0.0 to 2.0. Overall, the pain score associated with USCOM was significantly higher than that associated with BP measurement. However, the difference fails to reach the minimum clinically significant difference of one‐point. No significant difference was shown between boys and girls.ConclusionUSCOM appears to be tolerated well by healthy children. The discomfort reported during USCOM measurement is comparable to that associated with blood pressure measurements.
Evaluation of Chest Compression Depth during Nine Minutes of Hands‐Only Cardiopulmonary Resuscitation Performed by a Lone Rescuer and its Effect by Age Group: A Pilot Simulation Study Using a Manikin
Authors: Hong CK , Park SO , Choi CS , Lee YH , Sung AJ , Lee JH , Cho KW , Hwang SY 
Published: December 2017

ObjectiveThere have been few studies on the use of long‐standing hands‐only cardiopulmonary resuscitation (CPR) by a lone rescuer. This study aimed to evaluate the long‐standing (nine minutes) hands‐only CPR by a lone rescuer, and the change of chest compression depth over time. The effect of age of rescuer on chest compression depth was also studied.MethodsFrom a total of 404 adult lay‐persons who participated in CPR training, 91 subjects were enrolled in the simulation trial of nine minutes of hands‐only CPR using a manikin with a Skill‐Reporter™. The quality of the chest compression over time and the effects of rescuer age were analysed.ResultsOf the 91 participants, 74 (81%) fully completed the nine minutes of CPR. No significant differences of incomplete CPR rate between each age group were observed. No significant differences in the degree of reduction in effective chest compressions were observed based on the time course among the different age groups. The total number of compressions decreased abruptly from the six‐minute time point onwards (five minutes vs. six minutes, p=0.038).ConclusionsMost trained lay‐persons could complete the 9 minutes of hands‐only CPR. The rate of chest compression shows a significant decrease after 6 minute. We do not find a significant difference in the decrease of adequate chest compressions over time among various age groups in this pilot simulation study.