bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Outcomes of Pedestrian Casualties in Motor Vehicle Injuries Managed in Emergency Department
Authors: Leung CH , Lui CT , Tsui KL 
Published: December 2017

IntroductionPedestrian injury is a major health care concern. This study aims to identify predictors of mortality and severe injury in pedestrian casualties in motor vehicle injury managed in emergency department in the local setting.MethodsThis is a retrospective cohort study of a linked hospital and police trauma registry (2004 to 2008). All pedestrian casualties treated in the emergency department (ED) of two regional hospitals in Hong Kong were included. Logistic regression was performed for potential predictor variables (age >65 years; injury patterns including head or face, thorax/abdomen/pelvis, neck/spine, extremities; existence of multiple injuries; heavy vehicles involved; body impact with the vehicles; injury at night and wet road surface) against mortality and severe injury, defined as Injury Severity Scale (ISS) >15.ResultsA total of 1542 pedestrian casualties were analysed. Age >65 was found to be an independent predictor of mortality in pedestrian casualties, with odds ratio (OR) of 5.15 (95% CI=2.21‐12.00; p<0.001). Other independent predictors of mortality included injury to head/face (OR=4.52, 95% CI=1.75‐11.7, p=0.002), injury to thorax/abdomen/pelvis (OR=13.36, 95% CI=5.64‐31.6; p<0.001), multiple injuries (OR=4.0, 95% CI=1.06‐15.1; p=0.041) and wet road surface (OR=3.27, 95% CI=1.31‐8.17; p=0.011). These factors were also independent predictors for severe injury. Involvement of heavy vehicles and body impact with vehicles were not independent predictors of mortality. However, these were significant predictors of severe injury (OR=1.86 and 2.85 respectively).ConclusionOld age, injury to head/face or thorax/abdomen/pelvis, multiple injuries and wet road surface in accident scene are independent predictors for mortality in pedestrian casualties. In addition, involvement of heavy vehicles and body impact with vehicles are predictors of severe injury.
Agreement between Arterial and Venous Blood Gases In Emergency Medical Care: A Systematic Review
Authors: Kelly AM 
Published: December 2017

Aim The objectives of this review are to describe the agreement between arterial and venous blood gas values for pH, pCO2, bicarbonate and base excess. Methods MEDLINE search of papers published 1966-September 2012 for studies comparing arterial and peripheral venous blood gas values for any of pH, pCO2, bicarbonate and base excess in adult patients with any condition in an emergency department setting. The outcome of interest was mean difference weighted for study sample size. Results The weighted mean arterio-venous difference in pH was 0.034 pH units (n=2087), with narrow limits of agreement. The weighted mean arterio-venous difference for pCO2 was 6.2 mmHg (n=1043), but with 95% limits of agreement up to the order of ±20mmHg. Venous pCO2<45 mmHg has 100% sensitivity and negative predictive value for prediction of arterial hypercarbia (n=529). For bicarbonate, the weighted mean difference between arterial and venous values was −1.20 mEq/L (n=1403), with 95% limits of agreement of the order of ±5 mmol/L. Regarding base excess, the mean arterio-venous difference was 0.4 (n=295) but data are conflicting regarding the width of 95% limits of agreement. Conclusion For patients who are not in shock, venous pH and bicarbonate have sufficient agreement to be clinically interchangeable for arterial values. Agreement between arterial and venous pCO2 is too poor and unpredictable to be clinically useful as a one-off test but venous pCO2 may be useful to screen for arterial hypercarbia.
Elevated Aminotransferases are Predictors of Hepatic Injury in Blunt Abdominal Trauma Patients
Authors: Chang CH , Lin HJ , Liao YY , Chu FY , Chen KT 
Published: December 2017

ObjectiveComputed tomography (CT) scan is currently the most commonly used tool for evaluating solid‐organ injuries in trauma management. However, liberal use of CT scanning increases the risk of excess radiation exposure and toxicity from contrast material. Animal studies and clinical research on the paediatric population indicated that liver enzymes elevations were related to hepatic injury. The present study was undertaken to determine whether elevated liver enzymes were associated with the occurrence of hepatic injury in adult patients with blunt abdominal trauma.MethodsThis is a cross‐sectional study from August 2003 to October 2006. All adult patients with blunt injury to abdomino‐pelvic organs documented by CT or surgery who were admitted to Chi‐Mei Medical Centre in the captioned period were included. The study population sorted to hepatic injury (HI) and no hepatic injury (NHI) groups according to the presence or absence of hepatic injury. Variables including liver enzymes were compared between the groups.ResultsTotally 419 patients were included, including 150 patients in the HI group and 269 patients in the NHI group. The HI group was younger and had a lower rate of laparotomy (36.3 years old vs 41.4 years old; 26% vs 42%, respectively). The mean levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the HI group were significantly higher than levels in the NHI group (439.6 IU/L vs 104.7 IU/L; 353.5 IU/L vs 76.6 IU/L, p<0.01). We define AST >200 IU/L or ALT level >125 IU/L as abnormal according to previous studies. The diagnostic characteristics of hepatic injury were 87.3% sensitivity, 80.3% specificity, 71.2% positive predictive value, and 91.9% negative predictive value.ConclusionIn adults who have experienced blunt abdominal trauma, AST >200 U/L or of ALT >125 U/L are practical predictors of hepatic injury. Screening serum aminotransferases will have a role in detecting occult hepatic injury and may reduce the hazards of excessive CT scanning. (Hong Kong j.emerg.med. 2013;20:337‐342)
Ischaemic Stroke following Minor Head Trauma: A Case Report and Review of the Literature
Authors: Eken C , Serinken M , Armagan HH , Duman O , Cira K 
Published: December 2017

Head trauma is one of the leading causes of emergency department (ED) presentations. However, ischaemic stroke due to the minor head trauma is an unusual and unexpected condition for ED physicians. We report a ten‐month‐old boy was presented to the ED with disability in the left leg and arm. The child fell off the bed to the floor from a height of approximately 0.5 meter while sleeping. The cranial computed tomogram scan revealed a hypodense lesion in the posterior limb of right internal capsule that was consistent with brain infarct. ED physicians may consider a possible ischaemic stroke in children presented with minor head trauma without any pathological finding on the physical examination. (Hong Kong j.emerg.med. 2013;20:392‐395)
Predictors of Outcome in Out-Of-Hospital Cardiac Arrest Survived to Hospital Admission
Authors: Au WK , Tsui KL , Tang YH , Lui CT 
Published: December 2017

Objective To identify the independent predictors of survival to hospital discharge in the group of patients admitted to hospital with out-of-hospital cardiac arrest. Design Prospective cohort study. Setting Two public hospitals in a cluster in Hong Kong. Methods Data were reported to local Cardiac Arrest Registry using Utstein style template from 1st August 2010 to 31st October 2012. The post cardiac arrest care and outcome, premorbid mobility, activities of daily living (ADL) and medical illnesses were traced from medical records. Independent predictors were calculated using logistic regression model. Results A total of 323 patients were recruited in this study. Patients' age (Odds raio [OR]=0.966; 95% confidence interval [CI]=0.937-0.996), total down time (OR=0.897; 95% CI=0.858-0.938), pre-hospital defibrillation (OR=5.649; 95% CI=1.673-19.07), post-cardiac arrest intensive care (OR=3.674; 95% CI=1.001-13.951) were independent predictors of survival to hospital discharge. Conclusions Younger age, shorter down time, prehospital defibrillation for shockable rhythm, post-cardiac arrest intensive care are independent predictors of survival to discharge for patients admitted to hospital after out-of-hospital cardiac arrest. Premorbid health conditions, ADL and mobility are not predictors to patient's survival. (Hong Kong j.emerg.med. 2014;21:131-139)
Presentations of Runners in Kong Kong Marathon to a Local ED: A 10 Years' Glance
Authors: Chan PYN , Mok KL , Wong YT , Kan PG 
Published: December 2017

Objective To determine the basic characteristics, presentations, diagnoses and critical outcomes (heat Stroke, heat exhaustion, post-cardiac arrest and acute coronary syndrome) of patients in Accident and Emergency Department (AED) of Ruttonjee and Tang Shiu Kin Hospital (RHTSK) who participated in Hong Kong Marathon from 2003 to 2012. Methodology This was a simple descriptive epidemiology study to analyze patients who were participants of Hong Kong Marathon and attended AED of RHTSK for any complaint during or after the event. Results There were a total 170 participants who attended AED of RHTSK in these ten years; in which, 74.1% were male, with a mean (SD) age of 38.08 (11.29). Totally, 77.1% were non-trauma cases and 46.5% were critical/urgent cases (category in AED triage 1-3). Among all cases, 31.8% required admission, 4.1% were care in intensive care unit (ICU), 12.4% were managed in resuscitation room and 3.5% required intubation. The majority of cases were heat stroke and heat exhaustion. There were 4 cases of post cardiac arrest, 3 of them admitted to ICU after successful resuscitation. Number of critical/urgent cases increased with apparent temperature on Marathon Day. The correlation coefficient of percentage of critical/urgent cases with apparent temperature was 0.827 (p=0.011). Conclusion Total number of participants increased dramatically in Hong Kong Marathon throughout these ten years, participants' required medical attendance and emergency service also increased respectively. Number of critical/urgent cases increased with apparent temperature on Marathon Day. The majority of cases were heat-related illness, 4 cases presented with post cardiac arrest and one failed in resuscitation. (Hong Kong j.emerg.med. 2014;21:197-204)
A Survey of the Residents of Zhejiang, China on the Knowledge and Awareness of Community Cardiopulmonary Resuscitation and Expectation of the Emergency Medical Service
Authors: Tu JF , Yang Y , Cai WW , Chen H , Chen L , Zhou SA , Zhang MQ , Yang XH , Zhang K , He HQ 
Published: December 2017

Objectives To investigate the opinions and expectations of residents from Zhejiang Province on the prehospital emergency medical services (EMS). To evaluate the differences among main urban areas, county-level areas and rural areas in Zhejiang Province. To provide objective data for relevant departments to make further improvement and promote balanced development of the pre-hospital EMS cause. Methods The study was conducted from 1st April 2011 to 30th December 2011. It was carried out in 11 cities and 1,650 residents were included by stratified random sampling method. The survey mainly focused on residents' expectations of EMS and residents' knowledge of emergency skills, the emergency response time, the actions of EMS dispatchers, the fees charged for EMS. Pearson's Chi-Square Test was also used to compare the differences of the current status and residents' expectations of EMS among main urban areas, county-level areas and rural areas. Results The survey showed that the top four emergency skills most needed by residents are cardiopulmonary resuscitation (CPR), bandaging to stop bleeding, first aids for heatstroke and drowning. Trauma patients account for 37.5% (95% CI: 35.08-39.92%) of all those who received EMS service, ranking the first place. While the percentage receiving “wound care” was rated as the most needed emergency skill. There were statistically significant differences in the rate of knowing CPR, independently conducting CPR and emergency response time less than 5 minutes among main urban areas, county-level areas and rural areas in Zhejiang Province. Conclusions Residents of Zhejiang Province lack knowledge and awareness of emergency skills. Their mastery and expectation of emergency skills vary greatly from rural areas to urban areas. Trauma patients have become the main receiver of EMS in these three different regions. The emergency response time, as well as the services provided by EMS dispatchers, is far below the expectation of residents. In addition, the majority of respondents expect EMS to send patients to the nearest hospital and most of the trained paramedics are qualified for the pre-hospital care. (Hong Kong j.emerg.med. 2014;21:237-248)
Hong Kong Poison Information Centre: Annual Report 2013
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 2013. Methods In 2013, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,783 poisoned cases were analysed. There were 1,595 male patients (42.2%), 2,185 female patients (57.8%) and 3 sex unspecified patients (0.1%). Middle aged group (30-39 years) composed about one-fifth (20.8%) of the poisoning cases while about two-third (66.8%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (43%), unintentional exposure (15.3%) and abusive substances use (14.5%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, household products and Chinese herbal medicine. Majority of the patients were managed with supportive measures, and 13.2% and 10.8% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 4.3% had major outcomes. Conclusions This 8th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j. emerg.med. 2014;21:249-259)
Emergency Physician Job Satisfaction in Hong Kong
Authors: Shao Jf , Shen Hy 
Published: December 2017

Objective We aimed to explore the visibility of emergency medicine (EM) journals in mainland China based on the coverage by major indexing and abstracting information agencies and services. Methodology We first searched each journal by entering its title in Google's search engine, and then entered its home page to collect associated information, like publication cycle, journal language, publisher, editorial board, authors, and journal website. Second, to collect the inclusion information, totally ten databases were selected on the basis that they were considered as representative sources within the biomedicine. We adopted two forms for searching every journal: searching for every Chinese EM journal title (both English title and Chinese ‘ping yin’ title), and searching for the word ‘China’ from the fields provided for publisher of sources or for country of publication of sources indexed. Results Currently, in Mainland China, there were 13 EM journals, 12 in Chinese and one in English. Among them, both Science Citation Index Expanded (SCIE) and BIOSIS Previews (BP) did not include any EM journals; both MEDLINE and Abstract Journals (AJ) included only one, respectively; Scopus, EMBASE, Index Copernicus (IC), and Japan Science and Technology Agency (JST) indexed two journals, respectively; Western Pacific Region Index Medicus (WPRIM) included four journals, and Chemical Abstracts (CA) included six journals. Conclusion Only a few Chinese EM journals are indexed or abstracted in the international databases. More work should be done to achieve higher visibility of EM journals. (Hong Kong j.emerg.med. 2015;22:41-45)
Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl
Authors: Ozturk T Cimilli , Guneysel O , Akoglu H 
Published: December 2017

Objective Procedural Sedation and Analgesia is used in managing emergency painful procedures. The aim of this study is to compare the effects of propofol and midazolam on haemodynamic parameters when used in combination with fentanyl in isolated anterior shoulder dislocations and to measure the patient and physician satisfactions. Methods The study is a randomised single blind prospective trial. All procedural sedations were performed by emergency medicine specialists and the shoulder reductions were performed by orthopaedic surgeons. Two groups were defined. Group A received intravenous fentanyl and midazolam and Group B received intravenous fentanyl and propofol. The orthopaedic surgeons were not informed about the drugs. The emergency medicine specialist observed the patients. The patients and the orthopaedic surgeons were asked for a satisfaction scoring. Results Midazolam group consisted of 37 patients and propofol group consisted of 38 patients. Both groups were similar in demographic characteristics and pre-procedural vital signs. There was only one statistically significant difference at one time and it was the 5th minutes SpO2 levels between groups. There were statistically significant changes in the measurements of vital parameters in both groups when compared with the baseline levels. However none of them was clinically important. In midazolam and propofol group, 10.8% and 10.5% respectively had respiratory compromise. Patient and physician satisfactions were similar in both groups. Conclusions Midazolam and propofol are both relatively safe drugs using in combination with fentanyl in anterior shoulder dislocations. Patients and physicians can be highly satisfied with the two groups of drugs. (Hong Kong j.emerg.med. 2014;21:346-353)
Emergency Medical Service in Rural Mountain Areas in Taiwan: A Nantou Mountain Areas Based Study
Authors: Hung Sc , Li Yh , Chen Mc , Lai Sw , Sung Fc , Liu Ll , Chen Yr , Lin Kc 
Published: December 2017

BackgroundThis study explored the emergency medical service (EMS) in rural mountain areas in Taiwan to establish the public health policies in rural mountain areas.MethodsThis was a retrospective study. Based on mission records available at 3 EMS branches in Ren-Ai and Sinyi townships of Nantou County, we evaluated dispatched status, patient characteristics, and pre-hospital emergency managements.ResultsFrom January to June 2011, a total of 765 EMS were dispatched from these 3 mountain branches. Each dispatched EMS team was consisted of one official emergency medical technician (EMT) with EMT II certificate (100%), and one (88.0%) or two (11.2%) volunteers as EMT I personnel. Most of missions were conducted in the daytime and peaked during 10am to 12pm. Patients were characterised with more men and elderly and predominant with non-traumatic medical complains (55.0%). Approximately 38.7% EMS patients required the advanced life support. Of these 3 mountain EMS branches, the mean response time was 15.3±16.9 minutes, the mean management time on site was 6.1±6.9 minutes and the mean transport time was 38.0±15.9 minutes. The response time and transportation time of EMS in rural mountain areas were relatively longer than that in urban towns in Taiwan.ConclusionsThe rural EMS is under the challenges of providing appropriate and adequate medical care. Each EMS team should be equipped with adequate emergency care facilities and well trained personnel. (Hong Kong j.emerg.med. 2014;21:373-381)
Role of Dominant Hand Position during Chest Compression by Novice Rescuers: An Observational Simulation Study
Authors: Jo Ch , Ahn Jh , Shon Yd , Cho Gc 
Published: December 2017

Introduction The aim of this study was to determine the effect of hand positioning on the quality of external chest compression (ECC) by novice rescuers. Methods This observational simulation study was conducted for 117 included participants. After completion of an adult cardiopulmonary resuscitation (CPR) training program for 3-h, the participants selected which of their hands would be in contact with the mannequin during ECC and performed 5 cycles of single rescuer CPR on a recording mannequin. The participants were assigned to 2 groups: the dominant hand group (DH; n=40) and the non-dominant hand group (NH; n=29). The depth and rate of ECC were analysed to compare the effectiveness of ECC between 2 groups. Results The rate of ECC was significantly faster in the DH group (mean, 117.3 ±11.4/min) than in the NH group (mean, 110.9±12.2/min) (p=0.028). However, the depth of ECC in the dominant hand group (mean, 52.4±5.9 mm) was not significantly different from that in the non-dominant hand group (mean, 50.8±6.0 mm) (p=0.287). Similarly, the portion of ECC with inadequate depth in the dominant hand group (mean, 1.8±4.3%) was not significantly different from that in the non-dominant hand group (mean, 5.3±15.6%) (p=0.252). Conclusions ECC can be performed with an acceptably higher rate of compressions when the dominant hand of the novice rescuer is placed in contact with the sternum. However, the position of the dominant hand does not affect the depth of ECC. (Hong Kong j.emerg.med. 2014;21:382-386)
Effectiveness of a Modified 2-Rescuer Cardiopulmonary Resuscitation Technique Using a Bag-Mask for Less Experienced Health Care Providers: A Randomised Controlled Simulation Study
Authors: Shim Hw , Park So , Lee Yh , Yoo Yb , Hong Dy , Baek Kj , Lee Kr 
Published: December 2017

Objective To determine if a modified 2-rescuer cardiopulmonary resuscitation (CPR) method, in which the first rescuer performs chest compressions and squeezes the bag-mask during pauses in compression, and the second resuscitator uses 2 hands to provide an open airway, is useful for less experienced health-care providers (HCPs). Methods In this randomised control simulation study using a manikin, 82 less experienced HCPs were enrolled. After training on the conventional 2-rescuer CPR method (CM) (n=42) and the modified 2-rescuer CPR method (MM) (n=42), each participant performed 2-rescuer CPR for 5 cycles using their respective methods. All data were recorded in a personal computer and then analysed. Results The MM group generated a higher mean tidal volume (TV) (675.2 mL versus 320.0 mL for the CM) and higher median numbers of ventilation with the correct TV over 5 cycles (7 versus 3 breaths for the CM) (all p<0.001). However, there was no significant difference in the quality of chest compression and related interruption between the CM and MM groups. However, relatively higher median number of ventilations with large TV (2 versus 0 breaths for the CM) and higher median number of ventilations (3 versus 0 breaths for the CM) over 5 cycles were delivered in the MM group (all p<0.001). Conclusions Modified 2-rescuer CPR method (the first rescuer performs chest compressions and squeezes the bag-mask during pauses in compression, and the second resuscitator uses 2 hands to provide an open airway) can be useful as an alternative CPR method and is preferable to the conventional 2-rescuer CPR method for less experienced health-care providers. (Hong Kong j.emerg.med. 2015;22:23-30)