bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Six‐Year Observational Study on Acute Limb Ischaemia in a Local Emergency Department in Hong Kong
Authors: Yang SM , Chu NH , Lo CM , Tung WK 
Published: December 2017

IntroductionAcute limb ischaemia is an important presentation to accident and emergency department (AED). This study aimed to find out the sensitivity of AED colleagues on diagnosing acute limb ischaemia and any association between delayed diagnosis and poor outcome. Prognostic factors that might be associated with amputation and mortality rates were also investigated.MethodsThis was a retrospective observational study of patients admitted to Kwong Wah Hospital with a diagnosis of acute limb ischaemia over a six‐year period. The risk factors for acute limb ischaemia, the sensitivity of reaching the diagnosis at AED, and outcome in terms of amputation and 30‐day mortality post‐admission were assessed.ResultsThe sensitivity of Kwong Wah Hospital AED in diagnosing acute limb ischaemia was 78.3%. Advanced age, lower limb involvement and history of aortic graft were associated with higher risk of mortality. Patients diagnosed and referred by other sources, e.g. private practitioner, were also associated with higher mortality. Male sex, smoking and intravenous drug abuse were associated with higher amputation rate. Atrial fibrillation seemed to be a protective factor against amputation. Delayed diagnosis group comprised 22% of the cases. There was no significant difference in amputation and mortality rates between the early diagnosis and delayed diagnosis groups.ConclusionsAED physicians should always include acute limb ischaemia into the list of differential diagnoses. Further larger scale studies may be performed to investigate the impact of delay in diagnosis on outcome of patients.
Capnography: An Accurate Method to Assess the Position of the Feeding Tube in a Porcine Model
Authors: Lin CC , Lin CC , Lin HJ , Chen KT 
Published: December 2017

ObjectiveTo test the accuracy of capnography in the differential placement of feeding tubes into the trachea versus the oesophagus.MethodNineteen pigs were anesthetised, and feeding tubes were placed into their tracheas and oesophagi. A naïve examiner attached a capnography to the tube and evaluated the presence or absence of flow waveforms on the capnography. In the next step experiment, we gave 20 intentional oesophageal ventilations to the animals to create a distended stomach. The feeding tubes were reinserted, and examined by a naïve examiner by capnography.ResultsCapnography demonstrated continuous flow waveforms for the feeding tubes placed in the tracheas, but no waveforms were observed for those placed in the oesophagi. In the next step experiment, we found the same results.ConclusionCapnography can be used to accurately determine the placement of tracheal versus oesophageal feeding tubes based on the presence or absence of flow waveforms.
Effects of Drink Driving on Crash Risk Based on Random Breath Test Data
Authors: Li YC , Sze NN , Wong SC , Tsui KL , So FL 
Published: December 2017

Introduction Driving under the influence of alcohol (DUIA) is an important contributor to road crashes, injuries, and fatalities. Legal limits on drivers' breath alcohol concentration (BrAC) were first introduced in Hong Kong during the 1990s. Since then, the number of alcohol-related crashes has decreased. In 2009, police were empowered to conduct random breath tests (RBT) at roadblocks at any time. The availability of comprehensive RBT data allows us to determine the relationship between crash risk and BrAC, while controlling for confounding factors such as temporal distribution, road environment, and traffic conditions. Method In this study, we established two negative binomial regression models to analyse the risk of crashes in which people are killed or seriously injured (KSI crashes) and those involving only slight injuries on 182 urban road segments. Results Our results indicated that a higher mean BrAC markedly increases the risk of KSI crashes. However, there was no relationship between the risk of crashes involving slight injury and mean BrAC, although the absence of a hard shoulder, the presence of roadside parking bays, the dawn period, and the location noticeably increase the risk of these crashes. Conclusion It is worth exploring the benefits of remedial measures if comprehensive information on demographics and the driving habits of individual drivers become available in the future.
Effective Dose of Remifentanil for Control of Haemodynamic Response to Insertion of the Streamlined Liner of the Pharyngeal Airway
Authors: Kim WJ , Kang H , Yang SY , Shin HY , Baek CW , Jung YH , Woo YC , In JY 
Published: December 2017

ObjectiveTo determine the dose of remifentanil needed to achieve successful insertion of the Streamlined Liner of the Pharyngeal Airway (SLIPA™) without the development of hypertension in 95% of the patients.DesignRandomised controlled trial.Settingoperating theatre of a university hospitalMethodsA total of 100 ASA I or II patients requiring SLIPA insertion were randomly assigned to receive normal saline (Group C) or one of the four different doses (0.5 µg/kg [Group R0.5], 1.0 µg/kg [Group R1], 1.5 µg/kg [Group R1.5] or 2.0 µg/kg [Group R2]) of remifentanil. Arterial blood pressure and heart rate were recorded at preanesthetic baseline, preinserton, and every one minute during the initial 3 minutes period after insertion.ResultsA Probit model of remifentanil concentration was predictive of successful insertion of SLIPA without the development of hypertension. The ED95 of remifentanil needed to suppress haemodynamic response from SLIPA insertion was 1.39 µg/kg (95% confidence interval, 1.06‐2.61 µg/kg).ConclusionsA single administration of remifentanil can effectively suppress haemodynamic changes due to the insertion of SLIPA.
Evaluation of the Revised Trauma Score in Predicting Outcomes of Trauma Patients
Authors: Li H , Shen WF , He XJ , Wu JS , Yi JH , Ma YF 
Published: December 2017

IntroductionThe revised trauma score (RTS) was developed more than 20 years ago. Few studies investigated its usefulness in predicting trauma outcomes. This is especially true for the weighted version of RTS (RTS‐w). The aim of this study was to test the predicting power of RTS‐w for the trauma outcomes including mortality, admission to intensive care unit (ICU), hospital length of stay and ICU length of stay through a comparison with Injury Severity Score (ISS).MethodsDescriptive data, variables related to the trauma scores and outcomes were collected. The statistical performance of RTS‐w and ISS in predicting the trauma outcomes using receiver operating characteristics (ROC) curves and the area under the curve (AUC) with 95% confidence interval and p value were calculated. The Hosmer‐Lemeshow chi‐squared statistic was performed to measure its calibration.ResultsA total of 3323 patients were enrolled in the study. RTS‐w was significantly better than ISS in predicting mortality of trauma patients (AUC: 0.934 vs.0.880, p<0.0001). However, for the other three outcomes, i.e. admission to ICU, hospital length of stay and intensive care unit length of stay, the performance of RTS‐w was inferior to ISS.ConclusionsThe RTS‐w is a better predictor of mortality than ISS. But its ability to predict other trauma outcomes is not as good as ISS. More studies are needed to identify the predictive ability of RTS‐w for the outcomes other than mortality. Besides, updating the coefficients of the formula may make RTS‐w more accurate.
Effects of Different Treatment Options on the Prognosis of Wasp Stings
Authors: Xia JB , Xu SS , Yang L , Zhang XW , Zhong WQ , Peng AM 
Published: December 2017

Introduction Severe wasp sting injuries often threaten patient's life. We compared the effects of three different therapies on the prognosis of wasp stung patients. Methods We conducted a randomised single-blind controlled trial. Patients stung by wasp were randomly assigned to one of the three treatment groups: group A received symptomatic treatment; those complicated with acute renal failure and haemolysis also received haemoperfusion combined with haemodialysis; for patients with severe haemolytic anaemia, plasmapheresis were applied; for patients with haemodynamic instability, continuous renal replacement therapy was used. Group B received intravenous methylprednisolone injection, 80 mg/d for continuous 3 days in addition to the symptomatic therapy; for patients with haemolysis, methylprednisolone 0.5 g/d was injected intravenously for 3-5 days. For group C, in addition to all treatments administrated to group B patients, subcutaneous injection of 0.5 ml 0.1% epinephrine was given immediately after admission. Primary endpoint was mortality. Major complications (gastrointestinal haemorrhage, toxic encephalopathy, haemolysis, and acute left ventricular failure) and serum enzyme spectrum elevate (alanine aminotransferase [ALT], creatine kinase [CK] isoenzyme and serum creatinine) were secondary endpoints. Results Of 134 patients recruited, 45, 44 and 45 patients were assigned to group A, B or C respectively. Therapy in group C reduced mortality compared with group A and B (respectively 24.4%, 9.09%, 0.00% for group A, B, C respectively; p<0.001); there was no significant effects on major complications among three groups (p >0.1). The incidence of elevated ALT was significantly lower in group B and group C than in group A (p<0.001). The incidence of elevated CK isoenzyme was significantly lower in group C than in group A and group B (p<0.001). Conclusions For patients with concurrent organ impairment by wasp sting, early combination of epinephrine and methylprednisolone with supportive treatment with renal replacement therapy can effectively reduce the incidence of organ damage and mortality.
Prevalence and Predictors of Under-Diversion in the Primary Trauma Diversion System in Hong Kong
Authors: Wong CY , Lui CT , So FL , Tsui KL , Tang SYH 
Published: December 2017

Introduction Primary trauma diversion (PTD) enables direct transfer of major trauma patients to trauma centres for definitive care. This study aimed to evaluate the performance of PTD in the New Territories West Cluster (NTWC) of Hospital Authority and to identify the predictors for under-diversion. Methods A cross-sectional study based on local trauma registry. All major trauma patients (defined as ISS>15 or requiring trauma team activation) in the catchment area of the local hospital from September 2007 to December 2011 were included. The appropriateness of diversion decision was independently evaluated by an expert team (a trauma nurse coordinator and an emergency medicine practitioner). The sensitivity, specificity, predictive values, agreement, over-diversion and under-diversion rates were calculated. Potential predictors for under-diversion including age, Glasgow Coma Scale, mechanism of injury, injured body part, and the distance from scene to the trauma centre/local hospital were employed for logistic regression analysis. Results There were 141 eligible cases identified. The sensitivity and specificity for PTD were 59.5% and 96.5% respectively. The over-diversion rate was 3.5% and the under-diversion rate was 40.5%. The overall accuracy was around 74.5%. Non-motor vehicle accident (OR 13, 95% confidence interval [CI]=3.5-48.0, p<0.01) and isolated head injury (OR 5.35, 95% CI=1.5-19.5, p=0.01) were 2 independent predictors for under-diversion in PTD. Conclusions The overall field triage compliance by the paramedics is satisfactory. Under-diversion rate in NTWC is high. Non-motor vehicle accident mechanism and isolated head injury are 2 significant predictors for under-diversion. Reinforcement in training to avoid potential pitfalls would improve the paramedics' trauma triage performance.
Using an Electronic Bulletin Board Platform in a Disaster Tabletop Exercise
Authors: Wee JCP , Chong WCC , Lim GH 
Published: December 2017

Introduction We evaluate the use of an electronic bulletin board system in a tabletop disaster exercise. Methods Two tabletop exercises were carried out during a 5 hour course for 26 members of the Singapore Disaster Site Management Command (DSMC). As the events happened, the participants were updated via the electronic bulletin board. Response to the events was through the bulletin board. A written survey was held upon completion. Result Most (96.2%) felt that the exercise had helped identify issues in current operating procedures. The electronic bulletin board was deemed easy to use and learn, and that it helped in their learning (61.5%, 88.5% and 73.1% respectively). Using the electronic platform was an effective (76.9%) and efficient way (65.4%) of conducting the exercises. 53.8% of participants prefer the use of the electronic bulletin board and 61.5% felt that it was more realistic using the electronic platform. However the electronic bulletin board did not improve the participant's understanding of the current operating procedures (43.2%) and their role in DSMC (50%). Conclusion The use of the electronic platform is easy and over half of the involved participants thought it is preferred over the traditional tabletop exercise.
An Assessment of Oxidant/Antioxidant Status and Oxidative Stress Index Levels in Patients with Carbon Monoxide Poisoning
Authors: Zengin S , Kartal S , Al B , Orkmez M , Taysi S , Yildirim C 
Published: December 2017

ObjectiveThe purposes of this study is to evaluate the variations of total antioxidant status (TAS) and total oxidant status (TOS) levels in the treatment process of carbon monoxide poisoning (COP) and to learn more about the pathophysiology of COP.MethodsBetween 2011 and 2012, 113 patients were admitted to our emergency department with acute COP, and 50 healthy volunteers were used as a control group in this study. Serum, plasma and erythrocyte components were prepared for all the COP patients on admission. They were repeated at the 90th and 180th minute of treatment. The samples were taken once from the control group. Serum oxidant/antioxidant status levels and carboxyhaemoglobin (COHb) were measured. Ratio of TOS to TAS, known as oxidative stress index (OSI) was calculated.ResultsNo correlation was observed among age, gender, COHb level, with the levels of TAS, TOS, and OSI. Admission levels of TOS and OSI in patients with COP were higher than that observed at 90th minutes (p<0.001). These values were also higher in COP patients compared to control group (p<0.001). On the other hand, no statistical differences were observed in TAS levels between the study and control groups (p>0.05).ConclusionsOur results show that serum TOS and OSI levels increase in COP patients. Oxidative stress should play a role in the pathophysiology of COP. (Hong Kong j.emerg.med. 2013;20:352‐358)
Efficacy and Safety of Tenectaplase versus Streptokinase in Treating ST‐Elevation Myocardial Infarction Patients in Hong Kong: A Four‐Year Retrospective Review in Queen Elizabeth Hospital
Authors: Chau HW , Choi KK 
Published: December 2017

ObjectiveData were lacking in comparing tenectaplase (TNK) and streptokinase (SK) in treating Chinese ST elevation myocardial infarction (STEMI) patients. We sought to compare these 2 types of thrombolytics in our locality.MethodsWe analysed 196 STEMI patients who received either TNK or SK in our hospital from 2007 to 2011. We compared the mortality and other outcomes of these 2 groups of patients.ResultsIn‐hospital mortality has no significant difference between the TNK and the SK groups (8.9% vs 5.3%, p=0.322). Door‐to‐needle time was shorter in the TNK group (31±10 vs 25±7, p<0.001). Hypotension after drug administration was more common in the SK group than in the TNK group (21.1% vs. 3.0%, p<0.001).ConclusionTNK is at least as safe as SK in treating STEMI patients, with the advantage of shorter door‐to‐needle time and less frequent hypotensive effect. (Hong Kong j.emerg.med. 2013;20:359‐363)
Hong Kong Poison Information Centre: Annual Report 2012
Authors: Chan YC , Tse ML , Lau FL 
Published: December 2017

ObjectiveTo report and analyze the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2012.MethodsIn 2012, all poisoning cases received by HKPIC were retrieved from its database: Poison Information and Clinical Management System (PICMS) for analysis.ResultsA total of 4,814 poisoned cases were analyzed. There were 1,771 male patients (42.3%), 2,399 female patients (57.3%) and 14 sex unspecified patients (0.3%). Middle aged group (30‐39 years) contributed about one‐fifth (20.1%) of the poisoning cases while more than two‐third (67.7%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self‐harm/suicidal attempt (45%), abusive substances use (13.9%) and unintentional exposure (13.0%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, bites and envenomation and household products. Majority of the patients were managed with supportive measures, and 15.7% and 11.9% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.6% of the poison exposure resulted in death and 4.7% of the exposure had major outcomes.ConclusionsThis seventh annual report provides updated epidemiological information on poisoning pattern in Hong Kong and highlights important changes in comparing with our previous reports. (Hong Kong j.emerg.med. 2013;20:371‐381)
Hepatic Portal Venous Gas in a Patient with Penetrating Injuries
Authors: Chan CW , Yu CW , Lin CC , Lee CH 
Published: December 2017

Hepatic portal venous gas (HPVG) refers to the branching area of low attenuation extending to within 2 cm of the liver capsule in computed tomography scan. The most common causes of HPVG are mesenteric ischaemia in adults and necrotising enterocolitis in infants. HPVG in trauma patients is mostly reported in cases of blunt abdominal trauma. We present a deceased patient who had chest and abdominal wall penetrating injuries with concomitant hypovolemic shock. A computed tomography scan revealed HPVG and pulmonary artery air emboli. The mechanism of the presentation of HPVG in this patient and the possible cause of death would be discussed. (Hong Kong j.emerg.med. 2013;20:382‐384)
Spontaneous Rupture of Splenic Varices: A Rare but Lethal Complication of Portal Hypertension from Cirrhosis
Authors: Yang CH , Huang YC , Kuo WT 
Published: December 2017

Intra‐abdominal varices rupture is a rare but catastrophic complication in cirrhosis. We report our near‐miss experience in a woman presenting with acute abdominal pain and shock. This 55‐year‐old cirrhotic woman presented with sudden onset of epigastric pain. On arrival, her blood pressure was 57/49 mmHg and physical examination revealed epigastric tenderness without rebounding tenderness. Emergency ultrasonography (EUS) showed intra‐abdominal haemorrhage. Computed tomography revealed haemoperitoneum but no extravasation of contrast medium. She received conservative treatment first but laparotomy later for ongoing bleeding. Surgeon identified and ligated a ruptured splenic varix and she was discharged home after nine days of hospitalisation. This case report illustrates the use of bedside EUS in cirrhotic patients presenting with acute abdominal pain. (Hong Kong j.emerg.med. 2014;21:120‐123)
Heart Rate Variability Measurement in Sepsis Patients
Authors: Kim JY , Yoon YH , Park SM , Choi SH , Cho YD , Hong YS 
Published: December 2017

ObjectivesInflammation makes an influence on autonomic nervous system and a change in autonomic nervous activity affects heart rate. Heart rate variability (HRV) test can quantify the autonomous nervous activity. In this study, we evaluated the meaning of heart rate variability in sepsis patients.MethodsHeart rate variability test was performed for sepsis patients and healthy volunteers. Normalised low frequency power, reflecting sympathetic activity, was compared to acute physiology and chronic health evaluation II (APACHE II) score and mortality in emergency department sepsis (MEDS) score in sepsis patients. Then the patients were divided into four groups: 1) severe sepsis patients, 2) sepsis patients admitted to general ward, 3) sepsis patients discharged within 24 hours and 4) healthy volunteers. We obtained averages for the HRV results in all four groups. The receiver operating characteristics curve was examined to determine whether or not HRV variables could be used to triage sepsis patients.ResultsCorrelations between normalised low frequency power (LFnu) with APACHE II score and MEDS score were −0.595 and −0.514, respectively. Low frequency power (LF) and LFnu values decreased in sepsis patients with the higher scores observed in the discharged sepsis patients and healthy volunteers. The areas under the curve for the values of LF and LFnu in the admission and discharge groups were 0.746 and 0.635, respectively (p<0.05).ConclusionVariables related to heart rate variability are significantly correlated with the severity of sepsis patients. Although the HRV test alone cannot accurately predict the disposition of sepsis patients, in the emergency room setting it helps to assign beds to sepsis patients within the triage system, and avoid over‐population. (Hong Kong j.emerg.med. 2014;21:73‐79)
Acute Allergic Reactions in Emergency Medical Dispatch Centre: Predictors of Hospitalisation
Authors: Godet‐Mardirossian H , Descatha A , Dolveck F , Baer M , Fletcher D , Goddet NS 
Published: December 2017

IntroductionWe sought to identify symptoms predictive of hospitalisation of patients having the acute allergic reactions managed by an Emergency Medical Dispatch Centre in France.MethodsA prospective study was conducted from 20th August 2006 to 5th November 2006 on incoming calls to the Emergency Medical Dispatch Centre for the Hauts de Seine province, France. Statistical analyses were used to identify hospitalisation predictors. The validity of predictors identified was tested. We calculated equivalents of sensitivity (probability of presence of the sign when the reaction is severe), specificity (probability of absence of sign when the reaction is not severe), positive predictive value (probability of severe reaction when the sign is present) and negative predictive value (probability of non‐severe reaction when the sign is not present).ResultsA total of 210 calls were included. The following clinical hospitalisation predictors identified had very good specificity and good positive predictive value: facial oedema, sense of choking, respiratory distress, cough, difficulty speaking, dysphagia, abdominal pain, dizziness, collapse, and chest pain. However, none of the selected predictors had a safe negative predictive value (and sensitivity).ConclusionThis study has identified positive clinical predictors of hospitalisation for acute allergic reactions patients managed by a Medical Emergency Dispatch Centre. The next step will be a multicentre study in order to develop a severity score or a decision‐making algorithm. (Hong Kong j.emerg.med. 2014;21:80‐87)