bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of trauma injuries and predictors of in-hospital mortality in patients admitted to a tertiary care setting in Saudi Arabia
Authors: Abolfotouh Mostafa , Al-Marzoug Alanoud , Alteriqi Suliman , Al-Suwailem Abeer , Hijazi Ra'ed 
Published: May 2017

Background: Trauma is a major cause of death worldwide that can result death or permanent disability. Globally, 6–10% of all deaths are attributed to traumatic injuries. In Saudi Arabia, trauma is a public burden as a result of its socioeconomic impact. Our aim is to describe the pattern of traumatic injuries and predictors of in-hospital mortality among patients admitted through the ED of King Abdulaziz Medical City.

Methods: A retrospective cohort study was conducted on 3786 trauma-injured patients admitted from 2012 to 2014. Data on: patient characteristics, trauma characteristics and outcome characteristics, were extracted from a prospectively collected database. Logistic regression analysis and ROC curve were applied.

Results: Of 3786, (77.5%) of victims were males, (29.8%) injuries occurred in the age group (15–25 years). Blunt injuries constituted (87.1%), followed by burns (7%), intentional injuries (5%) and drowning & foreign body (1%). Data showed seasonal variation with two main peaks in March and August (p < 0.001). In-hospital mortality rate was (4.7%. Significant predictors of in-hospital mortality were age (p < 0.001), intubation need (p = 0.009), ISS (p < 0.001), RTS (p = 0.007), GCS (p = .004) and road traffic accidents (p = 0.001). The cut-off points for prediction of in-hospital mortality: were as follows: ISS = 22, AUC = 93%, ATS = 9, AUC = 78% and GCS = 8, AUC = 83%.

Conclusions: Our recommendation is targeted to ED policy makers to recognize the patterns of injury and the seasonal variation to structure and distribute the facilities and staff in a cost-effective manner. Also, enforcing trauma preventative measures should be encouraged. Secondly, for ED physicians to enhance the use of in-hospital predictors of mortality. Finally, educational programs targeting the general population are essential to cover all aspects.
High-dose potassium resuscitation in a peritoneal dialysis patient with severe hypokalemia and torsades de pointes
Authors: Baiou Anas , Yusof Alhady , Fituri Omar , Pathan Sameer 
Published: May 2017

Background: The American Heart Association (AHA) recommends to treat cardiac arrest due to Torsade de Pointes (TdP) with 1–2 grams of intravenous (IV) magnesium over 5 minutes. A second dose can be repeated within 5–15 minutes, and a continuous infusion may be considered. In cases of TdP due to severe hypokalemia, the doses and rate of administration of IV potassium chloride (KCL) are not described explicitly in the guidelines.

Methods: In this case report, we describe a peritoneal dialysis (PD) patient who had a prolonged history of hospital stay with infected diabetic foot. He was on the medical ward, but recently admitted to the Intensive Care Unit with septic shock needing inotropic support. He developed a TdP cardiac arrest with a serum potassium of 2.4 millimol/litre. We managed the cardiac arrest according to AHA guidelines and also administered a total of 120 milliEquivalent (mEq) of KCL over 2 hours. The severe refractory hypokalemia improved, and the recurrent TdP subsequently stopped only after we urgently drained the PD fluid during the resuscitation as a last resort. We also avoided administration of sodium bicarbonate even though he was severely acidotic during and after the resuscitation.

Results: To compliment this case report, we reviewed the literature available on hypokalemia in PD patient, and also on the established treatment of TdP.

Conclusion: In cardiac arrest situation secondary to hypokalemia, repeated high doses of IV KCL, up to a total of 120 mEq may be required, provided point of care testing is available. Draining the PD fluid during resuscitation, might expedite the correction of the refractory hypokalemia and malignant arrhythmias.
Reducing the time to disposition of patients with abdominal pain admitted to the Male Urgent Area ED-HGH
Authors: Joudeh Hussein Joudeh Fawwaz , Radhakrishnan Pradeep , Ghafour Biju , Qazaz Mustafa , Shaikh Hamza , Zainalabdeen Wala , Jinson J.K. 
Published: May 2017

Background: Abdominal pain is one of the most common presenting symptoms in Emergency Department. During a recent audit, it was found that Patients presenting to HGH emergency room with a chief complaint of abdominal pain are the most common patient's category to be delayed to disposition. Currently 62% of patients with abdominal pain admitted to Male Urgent Area in Emergency Department HGH were delayed to Disposition for more than 6 hrs.

Aim: To decrease the percentage of patients with abdominal pain delayed in Male Urgent Area ED, HGH for more than 6 hrs from 62% to 50% by May 2015 Project Scope; Project period: February 10th to 24th May 2015; Place: Male Urgent Area, Emergency HGH; Population: Male patients Expected Benefits of the project; Improve Patient Flow; Improve Patient safety; Improve patient Satisfaction.

Intervention: All abdominal pain patients must first be reviewed by the consultant of the See & Treat before transfer to male urgent area. Dedicated bed for reassessment of abdominal pain in Male Urgent Area. Flagging of patients when ready for reassessment.

Results: Post-intervention length of Stay Male Urgent Area has reduced by 2.28 hrs.

Conclusions: Early senior involvement has an impact on decreasing the Length of Stay in abdominal pain patients. Flagging patients for reassessment had an impact on the Length of Stay. It was very challenging to implement the changes and reach out to every staff being a big department.

Next steps: Quarterly Audit _ Publication of the Audit _ Continuous Education & Implementing to other Areas of the ED.
Injuries, motor vehicles, and adolescence: A case study from the United Arab Emirates
Authors: Barakat-Haddad Caroline , Siddiqua Ayesha 
Published: May 2017

Background: Globally, almost half of all adolescent deaths occur due to injury. Injuries related to accidental fall, being struck by an object or person, and road traffic injury (RTI) are particularly relevant among adolescents. Accidental falls and RTI are the most common causes of injury among children and adolescents. This study examines the profile of injuries among adolescents in the United Arab Emirates (UAE), including motor vehicle injuries (MVI), and identifies related factors associated with injury.

Methods: A cross-sectional study design determined incidence of injury for a sample of 6,363 adolescents aged 13 to 19 years. Data collected information on injury in the past 12 months, socio-demographic, behavioral, sensory data, and traffic-related behaviors. Logistic regression modeling was used to examine predictors of physical injury for the past 12 months, including injuries from motor vehicle collisions.

Results: Among participants, 18% experienced injury; the three top causes include accidental falls (38%), being struck by an object or person (18%), and MVI (13%). Identified risk factors that are amenable for prevention include smoking behavior, exposure to smoking, physical activity profile, family income, and speeding behavior. In relation to MVI, significant predictors are attending private schools (OR = 2.58), physical activity (OR = 1.11), family income (OR = 16.25), and speeding (OR = 2.34). Additionally, expatriates were less likely to experience MVI than locals.

Conclusion: Our findings highlight the need for public health policies and education programs that reduce injury among the UAE adolescent population. Future studies should build upon these findings to plan and implement tailored injury prevention strategies for this sub-population.
Cigarette smoking lowers blood pressure in adolescents: The Irbid-TRY
Authors: Alomari Mahmoud , Al-Sheyab Nihaya A. 
Published: May 2017

Background: Tobacco consumption adversely affects cardiovascular (CV) disease (CVD) and risk profile, including hypertension. The long-term effect of cigarette smoking on blood pressure (BP) in adolescents is still, however, equivocal. Thus, the current study examined the CV hemodynamics in male adolescent cigarette smokers versus non-smokers.

Methods: Resting heart rate, systolic (SBP) and diastolic (DBP) BP, mean arterial pressure (MAP), pulse pressure (PP), and rate pressure products (RPP) were examined using automatic oscillatory method, while smoking status was determined with Youth Risk Behavior Survey (YRBS).

Results: After covariating for cofactors, the ANCOVA showed that CV hemodynamics were lower (p < 0.05), in the male adolescent smokers versus non-smokers. Additionally, regression showed that smoking predicted the reduction in SBP (20.6%), DBP (5.0%), MAP (13.4%), PP (7.5%), and RPP (13.4%).

Conclusion: The results suggest that cigarette smoking lowers CV hemodynamics in adolescent. However, more studies are needed to describe the mechanism(s) for lowering CV hemodynamics and explain the relationship of adolescent smoking with adulthood CVDs.
The use of ice packs for pain associated with arterial punctures
Authors: Mayel Masoud , Bastami Mohammadreza , Azadi Arman 
Published: May 2017

Background: Arterial punctures for monitoring respiratory problems are one of the most painful procedures in hospitalized patients. The knowledge regarding non-pharmacologic methods of pain management, including cold application is limited.

Objective: This aim of this study was to determine if the application of ice packs before the procedure would decrease the pain perception of patients during the arterial puncture.

Materials and methods: This experimental study was undertaken among patients admitted to emergency ward in a public educational center affiliated to Ilam University of Medical Sciences, Ilam/Iran. Sixty-one eligible subjects were randomly assigned to two groups. The treatment group (n = 31) received ice packs before arterial puncture, whereas the control group (n = 30) received no intervention for pain management. Pain immediately and 5 minute after the arterial puncture were scored on a visual analog scale (VAS) from 0 to 10.

Results: The mean of pain score immediately after the arterial puncture were 3.12 (1.68) and 4.6 (1.56) for treatment and control group, respectively (p < 0. 001). The mean pain score 5 minute after the punctures were 1.9 (1.51) for treatment group and 2.53 (1.85) for control group. This difference was not statistically significant. The mean of heart rate during the procedure were 75.45 (9.76) beats/min for the treatment subjects and 75.46 (9.36) beats/min for the control group (p>0.05). Patients with previous arterial puncture reported higher pain intensity.

Conclusion: Cold packs is a simple, non-invasive and inexpensive technique for pain management before the arterial puncture. However, there is a need for further research regarding this topic.
Exploring the variables that impact on self-reported back in nurses working in critical care environments
Authors: Milligan Fiona , Hatamleh Aseel , Hassan Nesiya , Khial Noor , Sebastian Nirmala , Shaji Mincy , Shiju Shiny , Thomas Shiney , Almomani Emad , Alomari Hussein , Alsabou Abdelqader , Alatoum Ibrahim , Fernandez Dave , Okour Mohammad , Chandra Prem 
Published: May 2017

Background: There is little evidence of research outcome data or studies into self-reported back pain in Middle Eastern or Gulf region countries. Within HMC there is anecdotal evidence that suggests that back pain in nurses working in critical care environments accounts for a significant percentage of all sick cause leave. This has the potential to impact on productivity, patient care and quality of life in nurses working within critical care in environments.

Methods: A cross center mixed methodology study looking at back pain in nurses working in critical care environments data collection included demographic, occupational, and health characteristics and a Likert questionnaire. This comprised of 10 questions relating to manual handling education, equipment, staffing levels and ergonomics and was distributed in critical care and emergency departments across five hospital sites responses rate n = 450.

Results: Outcome data identified 65% of the respondents reported experiencing back pain over the last year with subsequent negative impact on quality of life. There was statically significant association between gender and quality of life p = 0.001; with more women verbalizing a negative impact on quality of life secondary to back pain. There were also statically significant relationships between age with younger age group reporting negative impact on quality of life p = 0.001 and length of time employed in HMC with respondents who have been employed between 1–5 years experiencing the greatest impact p = 0.001.

Conclusions: Back pain is an under reported occupational health concern that impacts on productivity and quality of life. Mandatory training in manual handling should feature in corporate educational agenda. Occupational health initiatives' are essential in the management of chronic health conditions.
Computed tomography (CT) scanning of the head before lumbar puncture in children with suspected meningitis: A prospective observational study
Authors: Al Yafei Khalid , Toaimah Fatihi , Hezam Khalid , El-Tatawy Lamia , Kamal Khalid C 
Published: May 2017

Background: Cranial computed tomography (CT) scan is a commonly performed neuroimaging prior to lumbar puncture (LP) in children with suspected meningitis to rule out intracranial hypertension or space occupying lesions. The purpose of this study was to assess the accuracy of physicians' prediction of CT abnormal cerebral findings in pediatric meningitis.

Subjects and methods: A prospective observational study design was performed over a 12-month period. Eligible patients were admitted to the Emergency Department (ED) where a structured questionnaire was filled independently by two physicians before undergoing cranial CT scan and prior to LP.

Results: In this study, 72 patients met the inclusion criteria with a mean age of 7.04 ± 3.38 years. The mean physicians' prediction score of abnormal CT findings was 6.0 ± 3.0 vs. 2.48 ± 2.01 of no abnormalities (difference 3.5 ± 1.0 (95% CI: 1.5, 5.5; p = 0.001). Relative risk of CT abnormalities associated with decreased level of consciousness was 7.33 (95% CI: 1.5, 33.67), Glasgow coma scale was 23.3 (95% CI: 7.7, 70.7), and abnormal posture was 8.9 (95% CI: 1.9, 41.7). Apart from mild headache (2.8%), vomiting (2.8%), dizziness (4.2%), no serious complications related to LP procedure have been reported.

Conclusion: Physician's clinical decision could predict absence of abnormal findings on cranial CT scan before LP in children with suspected meningitis. Our results suggest that LP could be performed with avoidance of CT scanning of the head in pediatric meningitis provided the presence of normal consciousness level, Glasgow coma scale ≥ 13 and normal neurologic examination.
Proteinuria as a biomarker of acute kidney injury in severe burn patients
Authors: Alsheikhly Ahmed Subhy Humadi , Alsheikhly Mazin 
Published: May 2017

Introduction: Proteinuria in burn patients is common, and it could be associated with acute kidney injury (AKI) with bad outcomes. We evaluated the incidences, outcomes, characteristics and determinants of proteinuria as a biomarker and its influence on AKI and outcomes in burn patients.

Methods: This retrospective study was carried out on a group of patients with burn injuries admitted though Emergency Department to burn unit of Hamad General Hospital during a five-year period. Positive urine analysis (R/M) readings were defined as mild ( ± or 1+) or heavy ( ≥ 2+) proteinuria, and AKI was diagnosed and staged according to the Risk, Injury, Failure, Loss, End Stage (RIFLE) classification system. Patient characteristics, management and outcomes were evaluated as well for associations with proteinuria.

Results: Of the selected admitted patients to the burn unit during the study period (n = 249), 86 (34.5%) were classified as having proteinuria. In the patients whose total burn surface areas (TBSA) were > 30% (n = 50), 37 patients (74%) had proteinuria and 27 of these patients (72.9%) met AKI criteria. No patients without proteinuria developed AKI. Intensive care unit (ICU) mortality rates were 1%, 16 % and 30% (P < 0.001) in the groups with no, mild and heavy proteinuria, respectively.

Conclusions: We observed a high prevalence of proteinuria in patients with severe burns (>30% TBSA). Severely burned patients with proteinuria had a high risk of developing AKI and a poor prognosis for survival. This suggests that proteinuria should be used as a biomarker for identifying burn patients at risk of developing AKI.
Predicting mortality of patients with cirrhosis admitted to medical intensive care unit: Experience of a single tertiary center in Qatar
Authors: Elzoi Abdel-Naser , Suliman Shireen , Alhasan Rania , Abdullah Ali , Badi Ahmed 
Published: May 2017

Background/aims: Prognosis for patients with cirrhosis admitted to medical intensive care unit (MICU) is poor. The objective of this study was to assess the predictors for hospital mortality and admission of cirrhotic patients to MICU in Qatar.

Materials and methods: We conducted a retrospective cohort study of consecutive adult cirrhotic medical-ICU patients whom hospitalized from 2007 through 2012 to Hamad General Hospital-Qatar. We compared them to cirrhotic patients who admitted to medical wards during same period of time. All data were recorded and analyzed with respect to demographic parameters, clinical features and laboratory as well as radiology characteristics on day one of admission to MICU. Cirrhosis diagnosis was established either with a liver biopsy or the combination of physical, laboratory and radiologic findings. Predictors of mortality were defined by logistic regression analysis.

Results: The cohort comprised 109 cirrhotic MICU patients, 86.2% were males and their mean age ± SD = 51.6 ± 11.5. MICU-cirrhotic had longer hospital length of stay (LoS) than medical wards-cirrhotic (both for survivors and non-survivors). Mortality was higher for the MICU-cirrhotic group than medical wards group (27 (24.8%) deaths vs. 12 (5.3%) deaths, respectively, p = 0.001). In multivariate logistic regression analyses, older age >60 years (p = 0.04), APATCH-II score (p = 0.001) and MELD score (p = 0.02) were independent predicting factors for overall mortality. Furthermore, admission with severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA score were independent predicting factors for MICU admission.

Conclusion: Severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA score predict MICU admission of cirrhotic patients. Among MICU cirrhotic patients, older age, APATCH-II score and MELD score predict mortality.
Marginal analysis in assessing factors contributing time to physician in Emergency Department using operations data
Authors: Moinudheen Jibin , Pathan Sameer A. , Bhutta Zain A. , Jenkins Dominic W. , Silva Ashwin D. , Sharma Yogdutt , Saleh Warda A. , Khudabakhsh Zeenat , Irfan Furqan B. , Thomas Stephen H. 
Published: May 2017

Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (hereafter tMD) between patients' initial ED presentation and initial physician evaluation.

Methods: The study was conducted using one month (May 2015) of an ED administrative database (EDAD), in HGH-ED, during the study month the ED saw 39,593 cases. The first step was generation of a multivariate model identifying the parameters associated with delay in tMD. In the second step, predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with STATA 14 MP, with significance defined at p < .05 and confidence intervals (CIs) reported at the 95% level.

Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r2 .51), important contributors to tMD included shift census (p = .008), shift time of day (p = .002), and physician coverage n (p = .004). Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p < .001) of consistent staffing with 22 physicians.

Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and physician n. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED.
Adherence to antimicrobial guidelines in the Emergency Department at a community hospital in Qatar
Authors: Abdelaziz Hani , Daoud Mohsen , Al-Mozien Shayma'a , Abdel Rhman Mahasin , Ahmed Arwa , Olabi Abeer , Al Hadi Hassan , Abdelaziz Osama , Mullaveettil Shaheed , Villa Spice , Ahmed Muayad , El Enany Rasha 
Published: May 2017

Background: Non-adherence to antimicrobial guidelines is a major factor leading to emergence of antimicrobial drug resistance.

Objective: This study was carried out to investigate the adherence to local antimicrobial guidelines in the Emergency Department (ED) at Al Wakra Hospital in the state of Qatar.

Materials and methods: This cross-sectional, retrospective study was carried out in the Emergency Department of Al Wakra Hospital in Qatar. Prescriptions of 219 patients were investigated to study the adherence to antimicrobial guidelines. The relation of sex, age and emergency unit type to antimicrobial adherence as well as the appropriateness of antimicrobial prescribed on discharge were also evaluated.

Results: Overall adherence and non-adherence to local antimicrobial guidelines was found to be 41% and 59% of prescriptions respectively (P-value = 0.007). Participants had mean age of 42 ± 15.5. More adherence to guidelines was found among female patients and in critical care units. Furthermore, antimicrobial prescribed to patients on discharge was found to be appropriate in 60% of patients (P-value = 0.04).

Conclusion: Education of physicians and additional studies should be conducted in order to further investigate and improve adherence to antimicrobial guidelines.
An unusual case of spontaneous rupture of the renal pelvis - A case report
Authors: Alkahky Sherif , Qotb Mohamed , Abdul Aziz Azhar 
Published: May 2017

Background: Spontaneous rupture of the renal pelvis is very rare and hence diagnosis may be delayed. Diagnosis of the rupture is best evaluated by CT and treatment is primarily removal of the underlying cause, followed by conservative management.

Presentation: An otherwise healthy 31-year-old male suffered abdominal pains and vomiting. His pain was at the right iliac fossa and suprapubic areas, which he rated as 7/10(NRS). He also reported dysuria of 2 days but with no other associated symptoms. On examination, Patient was vitally stable. On palpating his abdomen, there was right iliac fossa tenderness but no rebound tenderness, guarding nor rigidity, and the remainder of the examination was unremarkable. He received repeated analgesics; IV acetaminophen 1 g, 4 doses of IV fentanyl and in view of persistent pain and 2 additional doses of IV morphine. Abdominal ultrasonography were suggestive of distal right ureteric stone measuring 6 mm in diameter and mildly dilated upper and lower calyces with mild perinephric fluid. Along with, Tubular non-compressible structure 9 mm in diameter seen in RIF surrounded by minimal amount of fluid, giving an impression of query acute appendicitis with right distal ureteric stone. CT abdomen with double contrast revealed no features of acute appendicitis. However, there was a 4 mm stone in the lower end of the right ureter causing obstruction. Delayed series films showed rupture of the renal pelvis.

Conclusion: Rupture of renal calyx should be considered as one of the differential diagnosis for an unusual acute abdomen, not responsive to analgesics.