bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serial Measurement of Heart-Type Fatty Acid Binding Protein for the Rapid Diagnosis of Acute Coronary Syndromes in the Emergency Department
Authors: Limon O , Atilla R , Oray NC , Limon G , Doylan O 
Published: December 2017

Introduction We aimed to investigate the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP) at admission and the third and sixth hour after admission in patients presenting to the emergency department (ED) with chest pain or equivalent symptoms. Methods This prospective study was performed over two months in the ED. Patients presenting with ischaemic-type chest pain or other symptoms suggestive of myocardial ischaemia were included in the study. A bedside, point-of-care, quantitative H-FABP level was measured. If the initial electrocardiography (ECG) was non-diagnostic, the patients were observed for six hours. During the observation period, serial H-FABP measurements were obtained at admission, the third hour and the sixth hour; serial measurements of total creatine kinase (CK), CK-MB, troponin I and myoglobin were recorded at admission and the sixth hour. Results A total of 183 patients were included in the study. Initial H-FABP was measured in a joint group of ST segment elevation myocardial infarction (STEMI) and non ST segment elevation myocardial infarction (NSTEMI) patients, with a sensitivity of 80.9%, specificity of 19.2%, positive predictive value (PPV) of 23% and negative predictive value (NPV) of 77.1%. The third-hour H-FABP was measured in the NSTEMI group, with a sensitivity of 46.7%, specificity of 80.2%, PPV of 42.4% and NPV of 82.6%. The sixth-hour H-FABP had a sensitivity of 33.3%, specificity of 73.9%, PPV of 24.2% and NPV of 81.5%. Conclusion H-FABP is superior to myoglobin for diagnosing myocardial infarction in a joint group of STEMI and NSTEMI patients. The third-hour NPV value for H-FABP indicates that, for safety considerations, the cardiac observation time should not be shortened. (Hong Kong j.emerg.med. 2014;21:213-221)
Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia
Authors: Wong E , Ngo ASY , Wee JCP , Lee JMH 
Published: December 2017

Objective This study compares the positive predictive value (PPV) and negative predictive value (NPV) of focused assessment with sonography in trauma (FAST) versus abdominal-pelvic computed tomography scans (CTAP) after blunt abdominal injury as well as the need for abdominal surgery. We also sought to determine if any false negative ultrasound studies were associated with significant morbidity. The results were compared with other studies. Design Retrospective cross-sectional study. Setting A tertiary hospital. Methods Cases were retrieved from the trauma registry and electronic medical records in a tertiary hospital in Singapore over a two year period from 1 January 2009 to 31 December 2010. Exclusion criteria included penetrating trauma and burns. The sonographic finding, computed tomography finding, and the outcome of the patients were retrieved. Diagnostic characteristics including predictive values were calculated. Results A total of 476 patients were enrolled. Four hundred fifty-nine patients had FAST performed with fifty (10.9%) being positive. Forty-nine patients (21.7%) out of 226 patients had CTAP which showed abnormalities and nineteen (4.0%) patients underwent surgery. Comparing FAST to detect abnormalities on CTAP, the PPV and NPV were 0.590 and 0.863 respectively. Comparing FAST with the need for surgery, the PPV and NPV were 0.280 and 0.990 respectively. Four patients (0.98%) had negative FAST but required surgery. There were no significant adverse outcomes or surgical intervention in patients with normal vital signs, normal initial physical examination and negative FAST findings but who did not have a CTAP. Conclusions In patients with an initial normal physical examination and negative FAST, emergent CTAP may be avoided. (Hong Kong j.emerg.med. 2014;21:230-236)
Application of Bladder Scan in Ambulatory Management Protocol for Acute Urinary Retention with Presumed Diagnosis of Benign Prostatic Hypertrophy
Authors: Lai Ky , Chan Wk , Ho Wf , Leung Cs , Li Yk 
Published: December 2017

Objective Bladder scan was firstly used in the ambulatory management protocol for acute urinary retention (AUR) in Princess Margaret Hospital (PMH) emergency department (ED) since 2012. Bladder scan measurement was performed immediately after triage for early catheterisation in the new protocol for AUR. The primary objective of this study was to evaluate the accuracy of bladder scan in estimating the volume of urinary retention. The secondary objectives were to evaluate the change in unnecessary catheterisation rate and the change in door to catheterisation time (DTCT) after the implementation of new protocol. Setting Emergency department of a regional hospital. Methods Male patients over 40 years old presenting to the ED of PMH for difficulty to void within the study period were enrolled and managed according to the study protocol. Agreement analysis was carried out by the Bland and Altman method. The changes in DTCT were assessed by comparing data of current study and historical control. Results A total of 121 male patients were recruited. The bias between bladder scan readings and catheterised volume was 26.09 ml when the average bladder scan measurement and catheterised volume was 300ml. The 95% upper and lower limit were -95.82 ml and 151 ml, respectively. The relative risk reduction of unnecessary catheterisation was 90.9%. The absolute risk reduction was 8.26%. Number need to treat was 12 (95% CI 8-30). The DTCT of current study were shorter than that of historical control (DTCT: 22.85 minutes vs. 48.42 minutes; p<0.001). Conclusions Agreement between bladder scan readings and catheterised volume is satisfactory. Bladder scan can serve as a device to facilitate nurses to make decision on early catheterisation for AUR patients with presumed diagnosis of benign prostatic hypertrophy. (Hong Kong j.emerg.med. 2014;21:300-307)
A Study on the Medication Errors in the Administration of N-Acetylcysteine for Paracetamol Overdose Patients in Malaysia
Authors: Au V , Zakaria Mi 
Published: December 2017

Introduction N-Acetylcysteine (NAC) has been used to treat paracetamol overdose for four decades. But the administration of NAC regimens is complicated. Therefore, medication errors are an ongoing issue in the acute-care setting and directly impact the safety of patients. Objective To evaluate the rate of NAC-related medication errors during the management of paracetamol overdose at a teaching hospital in Malaysia. Methods This clinical audit study was performed retrospectively between June 2008 and June 2011. Patients who presented to the adult emergency department with paracetamol overdose and had received at least the loading dose of intravenous NAC were eligible. Children below the age of 12 years old were not included. Also, patients displaying chronic excessive paracetamol usage or recurrent paracetamol overdose were excluded. We determined the type and frequency of medication errors during intravenous NAC administration. Results The study population ranged from 13 to 87 years old (mean age: 25.06; median: 23) and was predominantly female. The overall prevalence of intravenous NAC-related medication errors was found to be 84.3%. Moreover, the following frequencies were observed based on error type: 5.9% wrong dose, 37.3% incorrect infusion rate, 8.5% interruption during treatment, and 66.5% unnecessary administration. Conclusion We observe a surprisingly high prevalence of medication errors related to the administration of intravenous NAC. Thus, this emerging issue needs be addressed in order to ensure patient safety as well as to prevent unnecessary hospital admissions and/or burdening treatment costs. (Hong Kong j.emerg.med. 2014;21: 361-367)
Pattern and Severity of Horse-Related Injuries Presenting to Emergency Room
Authors: Park Sm , Lim Sw , Ahn Hc , Lee Kj , Lee Yh , Ahn Jy , Sohn Yd 
Published: December 2017

Introduction Horseracing-related injuries have not been studied before in Korea in any detail, although horseracing takes place very regularly in the country. The injury rate is understandably high, owing to the weight of the horses and the speed they can achieve. The purpose of this study was to identify the incidence and the injury patterns of severe equestrian trauma, as well as the associated risk factors. Methods All patients with equestrian injuries who visited the emergency department (ED) between June 2007 and May 2011 were reviewed retrospectively. Results During the study period, 288 patients presented to ED with horse-related injury. Two hundred and eighty patients were enrolled in this study. The most common cause of the injury was a fall (168, 60.0%). The most common region of the injury was the face (123, 43.9%). The intermediate value of NISS was 3 (1-75). Thirty-two patients (11.4%) were diagnosed as having moderate to severe injury. Thoracic injuries occurred less often in cases of a fall. Facial and thoracic injuries occurred more often, however abdominal and pelvic injuries were not very common in cases of a clash. When thoracic injuries were accompanied by injuries to other parts of the body, the incidence of moderate to severe injury was very high. Conclusions Horseracing is a much rougher sport than general horse-riding. Therefore, one recommendation from this study is that jockeys who participate in horseracing should wear additional protective equipment other than a helmet and boots. (Hong Kong j.emerg.med. 2014;21:387-391)
Evaluation of the Effect of a Clinical Pathway on the Quality of Simulated Pre-Hospital Cardiopulmonary Resuscitation: Primary Experience from a Chinese Pre-Hospital Care Centre
Authors: Zhang Jg , Fu Wl , Qian Ln , Lu Ml , Zhang M 
Published: December 2017

Objective The aim of this study was to assess the quality of simulated cardiopulmonary resuscitation (CPR) in local pre-hospital care teams and the improvement achieved by using clinical pathways. Methods A prospective observation study. The 2010 American Heart Association Guidelines for CPR, the personnel characteristics of ambulance staff, China's legal system requirements, and the available medical resources were used to design a clinical pathway for pre-hospital care of cardiac arrest. Case simulations were used to evaluate the quality of CPR before and after implementation of the clinical pathway. Results The number of teams which successfully implemented electrocardiogram monitoring, endotracheal intubation and intravenous access before training were 8 (17.8%), 5 (11.1%) and 6 (13.3%) respectively. These increased to 45 (100%), 43 (95.6%) and 43 (95.6%), respectively, after training. The number of teams with successful implementation of artificial ventilation, airway management and insertion of oropharyngeal airway before training were 43 (95.6%), 38 (84.4%) and 12 (26.7%) respectively. These increased to 45 (100%), 42 (93.3%) and 43 (95.6%), respectively, after training. Nine (20%) teams decided CPR onsite before training and 35 (77.8%) after training. The average rate of chest compressions before and after training was 120.3 ± 17.9 and 123.2 ± 17.1 compressions per minute, respectively (p>0.05). Conclusion Training using established clinical pathway significantly improves the quality of CPR and increases the use of ALS techniques. CPR training requires ongoing validation and optimisation to maintain effectiveness. (Hong Kong j.emerg.med. 2015;22:14-22)
Holiday Fast-Track Reduced Medical Cost and Length of Emergency Department Stay: Preliminary Report from a Single Secondary Care Hospital
Authors: Lee Nk , Ahn Yr , Kim Yh , Lee Jh , Cho Kw , Hwang SY , Shin Ty , Ha Yr , Kim Ys , Hong Ck 
Published: December 2017

Introduction The aims of this study were to compare the effect of a Holiday Fast-Track (HFT) unit on medical costs and emergency department (ED) length of stay (LOS) associated with low acuity patients attended during the same timeframe in two consecutive years in a single secondary care hospital ED. Methods Two groups (non-HFT vs. HFT), before and after the fast-track unit was implemented, were compared. The HFT unit was operated to improve the flow of low acuity patients, which were defined as the patients classified as level 4 or 5 by the modified Canadian Triage and Acuity Scale. Data were collected from March 1 to April 30, 2011 for the non-HFT group and during the same period in 2012 for the HFT group. Results A total of 894 (431 for non-HFT period and 463 for HFT period) patients of acuity level 4 or 5 visited the ED during the study period. Compared to the non-HFT group, the ED LOS of the HFT group decreased by 27 min and 3.5 min in the patients with acuity levels 4 and 5, respectively (p=0.005 and p=0.003, respectively). Furthermore, total medical costs and laboratory fees were also reduced significantly in the HFT group (p<0.001, p=0.038). However, there was no difference in the other variables between those two groups. Conclusions The HFT system decreases the medical costs and LOS in low acuity patients visiting the ED of a secondary care hospital. (Hong Kong j.emerg.med. 2015;22:84-92)
Use of a Load Distributing Band Device (with Ventilation Prompts) during Cardiopulmonary Resuscitation
Authors: Annathurai A , Fook-Chong S , Lee Sh , Cheng Sy , Lee C , Shahidah N , Koh Zx , Ong Meh 
Published: December 2017

Introduction Over-ventilation can compromise coronary perfusion pressures during cardiopulmonary resuscitation (CPR) and should be minimised. We compared ventilations during manual and mechanical (load-distributing band - LDB) CPR, which gives ventilation prompts. Our primary objective was to compare the ventilation rate between manual CPR and LDB-CPR. Method This was a phased, non-randomised study at a tertiary hospital emergency department. All out-of-hospital, non-traumatic cardiac arrest adult patients during the study period from February 2007 till July 2008 were eligible. Pregnant females and patients aged less than 18 years of age were excluded. Ventilation rates in the first and second 5 minutes segments were recorded. Over-ventilation was defined as ventilation rate above 12 breaths per minute. All data analyses were performed with SPSS, version 17.0. Mean differences with 95% confidence interval (CI) were compared between the 2 treatment groups. Results From February 2007 till August 2007, there were 29 patients with manual CPR; and from September 2007 till July 2008, there were 62 with LDB-CPR. In the first 5 minutes of CPR, the proportion of patients that were over-ventilated, was 27.6% (manual) and 4.8% (LDB) (difference = 22.7%; 95% CI: 3.5-46.4%). In the next 5 minutes, the proportion of patients that were over-ventilated was 37.9% and 1.6% for manual and mechanical CPR respectively (difference = 36.3%; 95% CI: 16.5-58.9%). Conclusion Over-ventilation is reduced significantly in LDB-CPR compared to manual CPR during the first and second 5 minutes of resuscitation.
A Manikin Study Comparing McGrath Mac®and Airtraq®with Macintosh Laryngoscope in Tracheal Intubation by Intensive Care Unit Doctors
Authors: Chan HKW , Wong OF , Kwan GWM 
Published: December 2017

ObjectiveTo compare the performance of the McGrath Mac®and the Airtraq®with the Macintosh laryngoscope for tracheal intubation.DesignA manikin study with different simulated difficult airway scenarios.MethodsThirty intensive care unit (ICU) doctors (10 specialists and 20 non-specialists) performed intubation by using the 3 airway devices in the manikin with (i) normal airway, (ii) cervical rigidity, and (iii) tongue oedema. The intubation time, success rate, oesophageal intubation and number of episodes of dental injury were measured and compared.ResultsThe mean intubation time was significantly less by using the Airtraq®comparing to the McGrath Mac®in the manikin with normal airway (12.77 sec vs. 24.23 sec; p<0.001). Similarly, the mean intubation time was less by using Airtraq®when comparing to the McGrath Mac®in the manikin with cervical rigidity (12.73 sec vs. 17.5 sec; p=0.013). In the scenario of simulated tongue oedema, the mean intubation time of Airtraq®was shorter than Macintosh laryngoscope (24.83 sec vs. 34.20 sec; p=0.011) while there was no difference between Airtraq®and the McGrath Mac®. Less dental injury was noted when using the Airtraq®compared to the Macintosh laryngoscope in simulated cervical rigidity (p=0.005) and tongue oedema (p<0.001). Less dental injury was also noted when using the McGrath Mac®compared to the Macintosh laryngoscope in simulated tongue oedema (p<0.001).ConclusionEven with prior limited experience in using the McGrath Mac®, the performance of tracheal intubation by using this new device is comparable with the Airtraq®. The McGrath Mac®can be a good alternative for tracheal intubation in difficult airway situations. (Hong Kong j.emerg.med. 2015;22:337-344)
Contributory Factors to critically wrong road-crossing judgements among older people: an integrated research study
Authors: Loo Bpy , Tsui Kl 
Published: December 2017

Introduction Older people are having higher risk of vehicle-pedestrian collisions. This study examines the relative importance of different environmental, physical and cognitive factors in contributing to critically wrong road-crossing judgements. Methods An integrated research design is adopted. Older pedestrians were recruited through Elderly Community Centres in Hong Kong. Data about their physical and cognitive ability were collected through setting up outreach laboratories within the participants' neighbourhood communities. In addition to obtaining two walking speeds, three clinical tests (the visual acuity test, Timed Up and Go test and Mini Mental State Examination [MMSE] test) were conducted. A questionnaire survey collected personal information and activity data. Eighteen different road-crossing scenarios showing the same dual-lane one-way local road with different traffic conditions (a vehicle approaching at different distances, at different speeds, and on different lanes) were captured in videos and presented to the participants. Their decision time and judgement for each scenario were recorded in a computer. Apart from descriptive statistics, a binary logistic generalised estimating equation model was estimated. The dependent variable is whether a road-crossing judgement was critically wrong or not. Results and Conclusions A total of 7,182 road-crossing judgements of 399 older people were collected. The most statistically significant factors contributing to critically wrong road-crossing judgements are the road environment variables of the speed and distance of the oncoming vehicle. On physical variables, walking speed is the most important factor. Lastly, the cognitive variable of MMSE score is significant. For the mild and moderate impairment groups, the chances of making a critically wrong judgement are 1.83 and 2.01 times that of the normal group respectively.
Comparison of the GlideScope® with the Macintosh Laryngoscope in Endotracheal Intubation during Uninterrupted Mechanical Chest Compression: A Randomised Crossover Manikin Study
Authors: Yeung FSH , Lam RPK , Wong TW , Chan LW 
Published: December 2017

Background The GlideScope® (GS) has been shown to improve the first-attempt success rate of endotracheal intubation during continuous mechanical chest compressions compared with the conventional Macintosh laryngoscope (ML) in inexperienced hands. Yet, its value for operators with experience of emergency airway management has remained uncertain. We set out to compare their performance in the hands of experienced operators in a manikin receiving continuous mechanical chest compressions delivered by LUCAS®. Method This was a randomised crossover study. Thirty-five emergency physicians and intensivists performed intubation using GS and ML in 3 different scenarios: (1) normal airway without chest compressions; (2) normal airway with uninterrupted mechanical chest compressions; and (3) normal airway with cervical spine (C-spine) immobilisation and uninterrupted mechanical chest compressions. The sequence of scenarios and devices used were randomised. The primary outcome was the first-attempt success rate of intubation. Other data including demographics, the time required for successful intubation, complications during intubation, the visual analog scale of perceived difficulty of intubation and the preference on devices in each scenario were also collected and analyzed. Results In scenario 1, the first-attempt success rate with both laryngoscopes was 100%. In scenario 2, there was a higher first-attempt success rate with ML but it was not statistically significant (GS 97.14% vs ML 100%, p=1.00). In scenario 3, one participant failed to intubate in the first attempt with each of the laryngoscopes (GS 97.14% vs ML 97.14%, p=0.754). More dental compression was noted with GS but the difference was not statistically significant (GS 42.86% vs ML 22.86%, p=0.126). Overall, the median time for intubation with GS was significantly longer in all 3 scenarios (Scenario 1: GS 18.5s; interquartile range [IQR] 13.8 -22.2s vs ML 11.2s, IQR 9.5-14.2s, p<0.001; Scenario 2: GS 18.7s, IQR 13.1-25.2s vs ML 13.4s, 10.3-15.8s, p<0.001; Scenario 3: GS 20.8s, IQR 16.5-29.2s vs ML 14.0s, IQR 10.5-18.0s, p<0.001). More participants preferred GS in scenario 3, while ML remained the device of choice in the other two scenarios. Conclusion: GS is not superior to ML in terms of the first-attempt success rate of intubation and it takes significantly longer to intubate for experienced operator. Yet more participants prefer its use when the C-spine motion is limited. Further studies are warranted to explore its role in trauma resuscitation. (Hong Kong j.emerg.med. 2016;23:159-167)
Comparison of Risk Stratification Scores for Patients Presenting with Symptoms of Upper Gastrointestinal Bleeding in the Emergency Department
Authors: Lau Hk , Wong Ht , Lui Ct , Tsui Kl 
Published: December 2017

Objective To compare four scoring systems to predict outcomes in patients with symptoms of upper gastrointestinal bleeding presenting to the emergency department. Method A single centered prospective cohort study. All adult patients presenting to the emergency department of the studying centre with haematemsis or tarry stool or coffee ground vomiting or coffee ground aspirate from nasogastric tube were included from February 2012 to April 2012. The outcome variables include mortality, length of stay in hospital, blood product transfusion and interventions for bleeding control. The AIMS65 score, pre-endoscopic Rockall score, Glasgow Blatchford Score (GBS) and the modified Glasgow Blatchford Score (mGBS) were evaluated. Diagnostic characteristics were presented and areas under the receiver-operating-characteristic (AUROC) curve were compared. Results A total of 129 patients were included in the study. 81 of them (62.8%) had upper endoscopy performed. The mortality rate was 3.1%. Initial haemoglobin level of <10 was an important factor in risk stratification. Validation of the 4 scoring systems showed GBS had highest sensitivities (98.3-100%) and negative predictive values (90-100%) for all outcome variables but could not achieve a good specificity and positive predictive values against the outcomes. Both GBS and modified GBS outperformed the other two scoring systems in the AUROC curves in predicting composite high-risk outcome, length of stay in hospital and blood transfusion. Conclusion GBS appeared the best scoring system in the emergency department for screening purpose and to stratify those high risk patients for admission and low risk patients for out-patient management. (Hong Kong j.emerg.med. 2016;23:199-209)