Airway pressure release ventilation (APRV) has become increasingly popular for the management of acute respiratory distress syndrome (ARDS); however, its clinical impact remains a topic of debate. Furthermore, there is a gap between the guidelines and the actual clinical practices in mechanical ventilation management for ARDS. This survey aimed to explore the utilization of APRV and mechanical ventilation strategies for ARDS in Chinese intensive care unit (ICU) clinicians.A comprehensive 34‐item survey was distributed online platforms amongst ICU clinicians across mainland China from June to August 2019.A total of 420 valid responses were collected, with 57.4% (241) originating from academic hospitals and 42.6% (179) from non‐academic hospitals. Of the respondents, 98.6% (414) recognized the significance of low tidal volume ventilation for ARDS prognosis, 85.2% adhered to a tidal volume below 8 mL/kg predicted body weight, and most (46.4%) selected the initial positive end‐expiratory pressure within the range of 5–10 cmH2O based on experience. Among the respondents, 62.1% (261) reported familiarity with APRV and 41.9% (176) had implemented APRV. Of those who had utilized APRV, 93.2% (164) believed in its effectiveness for ARDS patients and 69.3% (122) advocated for early application of APRV. Substantial variations were noted regarding APRV initiation settings and the preservation of spontaneous breathing during APRV. Academic hospitals exhibited higher usage rates of lung recruitment, neuromuscular blockade, prone ventilation, and acquaintance with and utilization of APRV compared to non‐academic hospitals (all p values ≤ 0.001).Our findings highlight opportunities for improvement in mechanical ventilation management for ARDS, particularly in non‐academic hospitals. Additionally, a significant proportion of clinicians demonstrated limited knowledge of APRV, and there was a lack of consensus on its application. Further training and larger‐scale clinical trials are required to validate the efficacy and utilization of APRV in managing ARDS.
{"title":"Mechanical ventilation management and airway pressure release ventilation practice in acute respiratory distress syndrome: A cross‐sectional survey of intensive care unit clinicians in mainland China","authors":"Yinxia Lv, Xinyang Jin, MeiLing Dong, Lan Yang, Bo Wang, Guopeng Liang, Peng Wang, Xiaorong Jing, Yiyi Yang, Yunqing Yang, Zhen Wang, Xuelian Liao, Wei Yang, Shuo Zhu, Mandie Lu, Yang Kang, Yongfang Zhou","doi":"10.1002/hkj2.12033","DOIUrl":"https://doi.org/10.1002/hkj2.12033","url":null,"abstract":"Airway pressure release ventilation (APRV) has become increasingly popular for the management of acute respiratory distress syndrome (ARDS); however, its clinical impact remains a topic of debate. Furthermore, there is a gap between the guidelines and the actual clinical practices in mechanical ventilation management for ARDS. This survey aimed to explore the utilization of APRV and mechanical ventilation strategies for ARDS in Chinese intensive care unit (ICU) clinicians.A comprehensive 34‐item survey was distributed online platforms amongst ICU clinicians across mainland China from June to August 2019.A total of 420 valid responses were collected, with 57.4% (241) originating from academic hospitals and 42.6% (179) from non‐academic hospitals. Of the respondents, 98.6% (414) recognized the significance of low tidal volume ventilation for ARDS prognosis, 85.2% adhered to a tidal volume below 8 mL/kg predicted body weight, and most (46.4%) selected the initial positive end‐expiratory pressure within the range of 5–10 cmH2O based on experience. Among the respondents, 62.1% (261) reported familiarity with APRV and 41.9% (176) had implemented APRV. Of those who had utilized APRV, 93.2% (164) believed in its effectiveness for ARDS patients and 69.3% (122) advocated for early application of APRV. Substantial variations were noted regarding APRV initiation settings and the preservation of spontaneous breathing during APRV. Academic hospitals exhibited higher usage rates of lung recruitment, neuromuscular blockade, prone ventilation, and acquaintance with and utilization of APRV compared to non‐academic hospitals (all p values ≤ 0.001).Our findings highlight opportunities for improvement in mechanical ventilation management for ARDS, particularly in non‐academic hospitals. Additionally, a significant proportion of clinicians demonstrated limited knowledge of APRV, and there was a lack of consensus on its application. Further training and larger‐scale clinical trials are required to validate the efficacy and utilization of APRV in managing ARDS.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141684035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pneumonia is a leading diagnosis for patients requiring critical care. Prediction of the causal organisms has proved challenging, and antibiotic overuse is a burning issue.This study aimed to compare the results of the BioFire FilmArray Pneumonia Panel (PN Panel) to standard diagnostic methods and evaluate its potential impact in an intensive care unit (ICU).This is a retrospective study including adult patients admitted to the ICUs with a diagnosis of pneumonia. The agreement between the PN panel results and the standard diagnostic method was analyzed. Actual and potential adjustments of antimicrobials after the PN panel results were reviewed and compared.Two hundred ninety three patients with pneumonia were included. The PN panel identified at least one pathogen in 159 specimens (54.2%), while the standard diagnostic method identified at least one pathogen in 132 specimens (45.0%). Positive percentage agreement between the PN panel and standard‐of‐care culture reached 94%, and negative percentage agreement reached 97%. Among 293 patients, the availability of PN results led to escalation of antimicrobials in 38 (19%) patients and de‐escalation or discontinuation of antimicrobials in 95 (32.4%) patients.This pilot study showed the PN panel could provide accurate results on the causative pathogens and detect resistant bacteria. It could reduce the use of broad‐spectrum antibiotics and overall antibiotic use. If the PN panel could be checked at the emergency department, targeted antibiotics could be administered when the patient arrived at the ICU.
{"title":"Comparison of film array pneumonia panel to routine diagnostic methods and its potential impact in an adult intensive care unit in Hong Kong and the potential role of emergency departments","authors":"Ping Wu, Kin Ho Steven Ling","doi":"10.1002/hkj2.12018","DOIUrl":"https://doi.org/10.1002/hkj2.12018","url":null,"abstract":"Pneumonia is a leading diagnosis for patients requiring critical care. Prediction of the causal organisms has proved challenging, and antibiotic overuse is a burning issue.This study aimed to compare the results of the BioFire FilmArray Pneumonia Panel (PN Panel) to standard diagnostic methods and evaluate its potential impact in an intensive care unit (ICU).This is a retrospective study including adult patients admitted to the ICUs with a diagnosis of pneumonia. The agreement between the PN panel results and the standard diagnostic method was analyzed. Actual and potential adjustments of antimicrobials after the PN panel results were reviewed and compared.Two hundred ninety three patients with pneumonia were included. The PN panel identified at least one pathogen in 159 specimens (54.2%), while the standard diagnostic method identified at least one pathogen in 132 specimens (45.0%). Positive percentage agreement between the PN panel and standard‐of‐care culture reached 94%, and negative percentage agreement reached 97%. Among 293 patients, the availability of PN results led to escalation of antimicrobials in 38 (19%) patients and de‐escalation or discontinuation of antimicrobials in 95 (32.4%) patients.This pilot study showed the PN panel could provide accurate results on the causative pathogens and detect resistant bacteria. It could reduce the use of broad‐spectrum antibiotics and overall antibiotic use. If the PN panel could be checked at the emergency department, targeted antibiotics could be administered when the patient arrived at the ICU.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141344101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kwong Tat Lo, Chun Hei Kwok, Kenneth Kin Wing Suen
Although point‐of‐care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic tool during the management of out‐of‐hospital cardiac arrest (OHCA), opposing viewpoints exist. The objectives of this study are to investigate the knowledge, attitude, and practice (KAP) in POCUS utilization during OHCA among emergency medicine (EM) physicians in Hong Kong and to identify their barriers.A cross‐sectional questionnaire was conducted among EM physicians in 9 accident and emergency departments in Hong Kong. The questionnaire assessed participants' demographics, knowledge, attitude, practices, and barriers on this issue. Composite scores for KAP were calculated. Subgroup analysis and multiple regression analysis were used to explore the correlation between KAP and participants' demographics. Participants' barriers were evaluated by binary and open‐ended questions.A total of 224 questionnaires were distributed and 150 questionnaires were returned (response rate: 67.0%). Statistically significant associations of knowledge and attitude with practice were demonstrated (both p < 0.001). Independent predictors of more frequent POCUS use in OHCA included EM fellowship status (p = 0.005), receiving training on this issue (p < 0.001), and working in large hospitals (p = 0.007). The top‐ranked barriers were chaotic environment (74%), no structural education on this practice (63%), and the lack of staff (61%).The knowledge and attitude of performing POCUS during OHCA were demonstrated to enhance EM physicians' practice. By improving physicians' knowledge and removing the possible barriers they are facing, POCUS can be optimally utilized during OHCA to improve patient care.
{"title":"Questionnaire survey on point‐of‐care ultrasound utilization during cardiac arrest among emergency physicians in Hong Kong","authors":"Kwong Tat Lo, Chun Hei Kwok, Kenneth Kin Wing Suen","doi":"10.1002/hkj2.12024","DOIUrl":"https://doi.org/10.1002/hkj2.12024","url":null,"abstract":"Although point‐of‐care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic tool during the management of out‐of‐hospital cardiac arrest (OHCA), opposing viewpoints exist. The objectives of this study are to investigate the knowledge, attitude, and practice (KAP) in POCUS utilization during OHCA among emergency medicine (EM) physicians in Hong Kong and to identify their barriers.A cross‐sectional questionnaire was conducted among EM physicians in 9 accident and emergency departments in Hong Kong. The questionnaire assessed participants' demographics, knowledge, attitude, practices, and barriers on this issue. Composite scores for KAP were calculated. Subgroup analysis and multiple regression analysis were used to explore the correlation between KAP and participants' demographics. Participants' barriers were evaluated by binary and open‐ended questions.A total of 224 questionnaires were distributed and 150 questionnaires were returned (response rate: 67.0%). Statistically significant associations of knowledge and attitude with practice were demonstrated (both p < 0.001). Independent predictors of more frequent POCUS use in OHCA included EM fellowship status (p = 0.005), receiving training on this issue (p < 0.001), and working in large hospitals (p = 0.007). The top‐ranked barriers were chaotic environment (74%), no structural education on this practice (63%), and the lack of staff (61%).The knowledge and attitude of performing POCUS during OHCA were demonstrated to enhance EM physicians' practice. By improving physicians' knowledge and removing the possible barriers they are facing, POCUS can be optimally utilized during OHCA to improve patient care.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141103895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tsz Kit Chan, C. Lui, Wing Yee Clara Wu, Timothy Rainer, Chin San Leung
To evaluate the prevalence of burnout, its underlying personal or occupational stressors, and impact on individual well‐being and patient care.Cross‐sectional survey.All emergency physicians in the public and the private sector in Hong Kong.Self‐administered, anonymous, voluntary questionnaires were distributed in physical and electronic forms from April to June 2022. Burnout was assessed by the Maslach Burnout Inventory (MBI). Stressors were assessed by questions on demographic, occupational, and social background. Impact was assessed by the Patient Health Questionnaire‐9 (PHQ‐9) for depression and questions on job satisfaction and self‐perceived patient care.The response rate was 37.8% (n = 241). Prevalence of high overall burnout was 28.2% (n = 68), with 47.7% (n = 115) having high emotional exhaustion, 63.1% (n = 152) high depersonalization, and 56% (n = 135) low personal accomplishment. A higher burnout rate was observed in younger age, female, not married, job position (associate consultant, resident specialist, and higher trainee), working on shift duty, more night shifts, and consecutive shifts. Burnout is also associated with depression, suicidal idea, consideration of quitting, less job satisfaction, and less favorable patient care (p < 0.05).Burnout is prevalent in emergency physicians in Hong Kong, and its impact on individual well‐being and clinical care was evident. A higher burnout rate was observed in younger doctors and also fellows. Identified stressors such as shift pattern should be addressed and potentially improved. Further strategies should be explored to reduce burnout in our colleagues.
{"title":"Burnout in emergency physicians in Hong Kong—A cross‐sectional study on its prevalence, associated factors, and impact","authors":"Tsz Kit Chan, C. Lui, Wing Yee Clara Wu, Timothy Rainer, Chin San Leung","doi":"10.1002/hkj2.12025","DOIUrl":"https://doi.org/10.1002/hkj2.12025","url":null,"abstract":"To evaluate the prevalence of burnout, its underlying personal or occupational stressors, and impact on individual well‐being and patient care.Cross‐sectional survey.All emergency physicians in the public and the private sector in Hong Kong.Self‐administered, anonymous, voluntary questionnaires were distributed in physical and electronic forms from April to June 2022. Burnout was assessed by the Maslach Burnout Inventory (MBI). Stressors were assessed by questions on demographic, occupational, and social background. Impact was assessed by the Patient Health Questionnaire‐9 (PHQ‐9) for depression and questions on job satisfaction and self‐perceived patient care.The response rate was 37.8% (n = 241). Prevalence of high overall burnout was 28.2% (n = 68), with 47.7% (n = 115) having high emotional exhaustion, 63.1% (n = 152) high depersonalization, and 56% (n = 135) low personal accomplishment. A higher burnout rate was observed in younger age, female, not married, job position (associate consultant, resident specialist, and higher trainee), working on shift duty, more night shifts, and consecutive shifts. Burnout is also associated with depression, suicidal idea, consideration of quitting, less job satisfaction, and less favorable patient care (p < 0.05).Burnout is prevalent in emergency physicians in Hong Kong, and its impact on individual well‐being and clinical care was evident. A higher burnout rate was observed in younger doctors and also fellows. Identified stressors such as shift pattern should be addressed and potentially improved. Further strategies should be explored to reduce burnout in our colleagues.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140964026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pitsucha Sanguanwit, C. Yuksen, J. Khorana, Yuranun Phootothum, Siriporn Damdin, Krongkarn Sutham
Older patients face increased sepsis risk, requiring precise prognostic tools in the emergency department (ED). This study aimed to explore factors predicting 28‐day mortality among older (≥60 years) patients with suspicion of sepsis in the ED.We performed a retrospective cohort study. Data for all older patients with clinical suspected sepsis presenting to the ED from 1 October 2018 to 31 December 2018, were collected. Prognostic factors, characteristics, comorbidities, vital signs at triage, the emergency severity score, initial laboratory results, and sepsis bundle treatment were analyzed using univariable and multivariable Cox regression. Hazard ratios (HR) were calculated using these analytical methodologies to prognosticate 28‐day mortality.A total of 329 older patients with suspected sepsis were included. The overall 28‐day mortality was 10.33%. Independent prognostic factors that were significantly associated with 28‐day mortality were malignancy (adjusted hazard ratio [aHR]: 3.67; 95% confidence interval [CI]: 1.90, 7.09; p < 0.01), oxygen saturation ≤93% (aHR: 3.37; 95% CI: 1.79, 3.43; p < 0.01), and dependent status (hazard ratio [HR]: 2.27; 95% CI: 1.14, 4.53; p = 0.02).This study suggests that “MOD”; M‐Malignancy, O‐Oxygen saturation ≤93%, and D‐Dependent status are significant prognostic indicators for 28‐day mortality among older patients with suspected sepsis in the ED.The trial was retrospectively registered in the Thai Clinical Trial Registry on 06/05/2022, identification number TCTR20220506006.
{"title":"Factors for predicting 28‐day mortality in older patients with suspected of having sepsis in the emergency department","authors":"Pitsucha Sanguanwit, C. Yuksen, J. Khorana, Yuranun Phootothum, Siriporn Damdin, Krongkarn Sutham","doi":"10.1002/hkj2.12023","DOIUrl":"https://doi.org/10.1002/hkj2.12023","url":null,"abstract":"Older patients face increased sepsis risk, requiring precise prognostic tools in the emergency department (ED). This study aimed to explore factors predicting 28‐day mortality among older (≥60 years) patients with suspicion of sepsis in the ED.We performed a retrospective cohort study. Data for all older patients with clinical suspected sepsis presenting to the ED from 1 October 2018 to 31 December 2018, were collected. Prognostic factors, characteristics, comorbidities, vital signs at triage, the emergency severity score, initial laboratory results, and sepsis bundle treatment were analyzed using univariable and multivariable Cox regression. Hazard ratios (HR) were calculated using these analytical methodologies to prognosticate 28‐day mortality.A total of 329 older patients with suspected sepsis were included. The overall 28‐day mortality was 10.33%. Independent prognostic factors that were significantly associated with 28‐day mortality were malignancy (adjusted hazard ratio [aHR]: 3.67; 95% confidence interval [CI]: 1.90, 7.09; p < 0.01), oxygen saturation ≤93% (aHR: 3.37; 95% CI: 1.79, 3.43; p < 0.01), and dependent status (hazard ratio [HR]: 2.27; 95% CI: 1.14, 4.53; p = 0.02).This study suggests that “MOD”; M‐Malignancy, O‐Oxygen saturation ≤93%, and D‐Dependent status are significant prognostic indicators for 28‐day mortality among older patients with suspected sepsis in the ED.The trial was retrospectively registered in the Thai Clinical Trial Registry on 06/05/2022, identification number TCTR20220506006.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140986657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study is to investigate how lifestyle changes affect the emergency department (ED) presentations of pediatric patients with acute traumatic injuries during the COVID‐19 pandemic.This retrospective cohort study was conducted in the ED of Akdeniz University Hospital. We analyzed the medical records of pediatric patients who presented to our ED with acute traumatic injury during the 52‐week period after March 16, 2020, which marks the official date when in‐person education was suspended in Turkey due to COVID‐19. These records were compared with those from the 52‐week period prior to March 16, 2020 (pre‐COVID). Patients with nontraumatic presentations or follow‐up visits (e.g., dressing, suture removal, injection, etc.) were excluded from the study. The data was obtained through the Hospital Information System.The total number of ED pediatric trauma visits declined by 46%. The overall presentation rates of patients between the ages of 1 and 4 years, home injuries, falls, burns, hospitalizations, and costs per patient increased during COVID‐19. In contrast, the rate of motor vehicle accidents, sports injuries, and injuries that occurred at schools and playgrounds decreased.It should be expected that the decrease in the number of acute trauma presentations due to the implementation of distance education and lockdown restrictions will increase after the pandemic. As a result, it is necessary to pay attention to the safety of children in streets, playgrounds, and schools as the pandemic ends, as much as it will continue to be important to create safe environments for children at home. In order to reduce mortality and morbidity due to pediatric traumatic injuries, all authorized people, including the relevant ministries, should take precautions to protect children from injuries, and pediatric trauma should be addressed as a preventable public health problem.
{"title":"The impact of COVID‐19 pandemic on pediatric traumatic injury and demographic presentations to a university emergency department","authors":"Mehmet Arikan, Cem Oktay","doi":"10.1002/hkj2.12021","DOIUrl":"https://doi.org/10.1002/hkj2.12021","url":null,"abstract":"The objective of this study is to investigate how lifestyle changes affect the emergency department (ED) presentations of pediatric patients with acute traumatic injuries during the COVID‐19 pandemic.This retrospective cohort study was conducted in the ED of Akdeniz University Hospital. We analyzed the medical records of pediatric patients who presented to our ED with acute traumatic injury during the 52‐week period after March 16, 2020, which marks the official date when in‐person education was suspended in Turkey due to COVID‐19. These records were compared with those from the 52‐week period prior to March 16, 2020 (pre‐COVID). Patients with nontraumatic presentations or follow‐up visits (e.g., dressing, suture removal, injection, etc.) were excluded from the study. The data was obtained through the Hospital Information System.The total number of ED pediatric trauma visits declined by 46%. The overall presentation rates of patients between the ages of 1 and 4 years, home injuries, falls, burns, hospitalizations, and costs per patient increased during COVID‐19. In contrast, the rate of motor vehicle accidents, sports injuries, and injuries that occurred at schools and playgrounds decreased.It should be expected that the decrease in the number of acute trauma presentations due to the implementation of distance education and lockdown restrictions will increase after the pandemic. As a result, it is necessary to pay attention to the safety of children in streets, playgrounds, and schools as the pandemic ends, as much as it will continue to be important to create safe environments for children at home. In order to reduce mortality and morbidity due to pediatric traumatic injuries, all authorized people, including the relevant ministries, should take precautions to protect children from injuries, and pediatric trauma should be addressed as a preventable public health problem.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140685439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Harun Yildirim, E. Armağan, Ataman Kose, S. Eraybar, E. Ahun, Pinar Cinar Sert
The aim of our study is to assess the relationship between altered consciousness in patients presenting to the emergency department (ED) without a history of trauma and the physiological changes associated with aging. Additionally, we aim to compare diagnostic differences between patients under the age of 65 and those aged 65 and above.This prospective study was conducted at the ED of Uludağ University Medical Faculty Hospital over a 1‐year period from December 2012 to November 2013. Patients aged 18 and above presenting with non‐traumatic altered consciousness were included, and they were categorized into two groups based on age: <65 years and ≥65 years. Comparison between age groups included gender, seasonal presentation, vital signs, consciousness level, Glasgow Coma Scale (GCS) score, requested consultations, diagnoses, and outcomes.Out of 646 patients, 312 (48%) were female, and 334 (52%) were male, with a mean age of 64.9 ± 16.4 years. The highest number of admissions for altered consciousness occurred during the summer season (n = 200, 31%). In the 65 and above age group, a statistically significant elevation was found in the mean systolic blood pressure (p < 0.05). In neurological diagnoses, cerebrovascular events were observed most frequently, while in non‐neurological diagnoses, endocrine/metabolic diseases were more common. It was observed that GCS scores were lower in neurological diagnoses (p = 0.020). Discharges were more frequent in the under 65 age group, with a statistically significant difference (p < 0.05). It was found that the mortality rate was higher in non‐neurological diagnoses, and this was statistically significant (p < 0.001).When determining the cause of altered consciousness in patients with such symptoms, a comprehensive understanding of physiological changes in elderly individuals is crucial. While high blood pressure may indicate neurological diagnoses, tachycardia, tachypnea, and fever may suggest non‐neurological causes.
{"title":"Comparative etiological analysis of critical patients presenting to the emergency department with altered consciousness across age groups: A prospective observational study","authors":"Harun Yildirim, E. Armağan, Ataman Kose, S. Eraybar, E. Ahun, Pinar Cinar Sert","doi":"10.1002/hkj2.12022","DOIUrl":"https://doi.org/10.1002/hkj2.12022","url":null,"abstract":"The aim of our study is to assess the relationship between altered consciousness in patients presenting to the emergency department (ED) without a history of trauma and the physiological changes associated with aging. Additionally, we aim to compare diagnostic differences between patients under the age of 65 and those aged 65 and above.This prospective study was conducted at the ED of Uludağ University Medical Faculty Hospital over a 1‐year period from December 2012 to November 2013. Patients aged 18 and above presenting with non‐traumatic altered consciousness were included, and they were categorized into two groups based on age: <65 years and ≥65 years. Comparison between age groups included gender, seasonal presentation, vital signs, consciousness level, Glasgow Coma Scale (GCS) score, requested consultations, diagnoses, and outcomes.Out of 646 patients, 312 (48%) were female, and 334 (52%) were male, with a mean age of 64.9 ± 16.4 years. The highest number of admissions for altered consciousness occurred during the summer season (n = 200, 31%). In the 65 and above age group, a statistically significant elevation was found in the mean systolic blood pressure (p < 0.05). In neurological diagnoses, cerebrovascular events were observed most frequently, while in non‐neurological diagnoses, endocrine/metabolic diseases were more common. It was observed that GCS scores were lower in neurological diagnoses (p = 0.020). Discharges were more frequent in the under 65 age group, with a statistically significant difference (p < 0.05). It was found that the mortality rate was higher in non‐neurological diagnoses, and this was statistically significant (p < 0.001).When determining the cause of altered consciousness in patients with such symptoms, a comprehensive understanding of physiological changes in elderly individuals is crucial. While high blood pressure may indicate neurological diagnoses, tachycardia, tachypnea, and fever may suggest non‐neurological causes.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140685800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"April 2024 global research highlights","authors":"","doi":"10.1002/hkj2.12019","DOIUrl":"https://doi.org/10.1002/hkj2.12019","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140734727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chi Yeung Yeung, Marc L. C. Yang, Yan W. Y. Kwong, T. Rainer
Malaria remains a significant cause of illness for return travellers in Hong Kong. However, the lack of experience of local healthcare providers in tropical medicine and non‐specific presenting symptoms may lead to underdiagnosis or delayed diagnosis of the disease. We evaluate patients presenting with malaria to a local emergency department to understand the disease presentation and outcome.A retrospective review of all patients diagnosed with malaria presenting to the emergency department from January 2009 to December 2019 was conducted. Information about patient demographics, travel history, presenting vital signs and blood results, how the diagnosis is made, clinical features and outcomes were analysed. Subgroup analysis was also performed for comparison.Among the 70 patients diagnosed with malaria, most of them were imported cases (98.6%). Most were infected with Plasmodium Falciparum (50%) and Plasmodium vivax (45.7%). The common presenting symptoms included fever (100%), nausea or vomiting (42.9%) and headache (38.6%). 43 out of 70 cases had a diagnosis made in the emergency department, either by malarial blood smear (34.3%) or incidental haematological findings (27.1%). Most cases could be discharged uneventfully (90%), with six cases requiring Intensive Care Unit admission during the stay (8.6%). Patients with diagnoses not made in AED had a significantly lower mean arterial pressure (p = 0.009) and haemoglobin level (p = 0.004). Significantly lower platelet count (p = 0.002) and higher bilirubin level (p = 0.041) were found in patients who required ICU admission. For those who had AED reattendance before diagnosis was made, their creatinine levels were significantly higher (p = 0.022) and had a longer length of stay (p = 0.021).The clinical presentation of imported malaria cases is non‐specific, and high suspicion of malaria should be raised when diagnosing febrile patients with a travel history. The history of taking malarial chemoprophylaxis is essential and should have been included in most cases. Malarial‐specific treatments were rarely given in the emergency department despite diagnosis.
{"title":"Characteristics and outcome of patients with malaria presented to a Hong Kong emergency department—A retrospective cohort analysis","authors":"Chi Yeung Yeung, Marc L. C. Yang, Yan W. Y. Kwong, T. Rainer","doi":"10.1002/hkj2.12015","DOIUrl":"https://doi.org/10.1002/hkj2.12015","url":null,"abstract":"Malaria remains a significant cause of illness for return travellers in Hong Kong. However, the lack of experience of local healthcare providers in tropical medicine and non‐specific presenting symptoms may lead to underdiagnosis or delayed diagnosis of the disease. We evaluate patients presenting with malaria to a local emergency department to understand the disease presentation and outcome.A retrospective review of all patients diagnosed with malaria presenting to the emergency department from January 2009 to December 2019 was conducted. Information about patient demographics, travel history, presenting vital signs and blood results, how the diagnosis is made, clinical features and outcomes were analysed. Subgroup analysis was also performed for comparison.Among the 70 patients diagnosed with malaria, most of them were imported cases (98.6%). Most were infected with Plasmodium Falciparum (50%) and Plasmodium vivax (45.7%). The common presenting symptoms included fever (100%), nausea or vomiting (42.9%) and headache (38.6%). 43 out of 70 cases had a diagnosis made in the emergency department, either by malarial blood smear (34.3%) or incidental haematological findings (27.1%). Most cases could be discharged uneventfully (90%), with six cases requiring Intensive Care Unit admission during the stay (8.6%). Patients with diagnoses not made in AED had a significantly lower mean arterial pressure (p = 0.009) and haemoglobin level (p = 0.004). Significantly lower platelet count (p = 0.002) and higher bilirubin level (p = 0.041) were found in patients who required ICU admission. For those who had AED reattendance before diagnosis was made, their creatinine levels were significantly higher (p = 0.022) and had a longer length of stay (p = 0.021).The clinical presentation of imported malaria cases is non‐specific, and high suspicion of malaria should be raised when diagnosing febrile patients with a travel history. The history of taking malarial chemoprophylaxis is essential and should have been included in most cases. Malarial‐specific treatments were rarely given in the emergency department despite diagnosis.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140372891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuet Hong Wu, Jeremy Ho Hei Chiu, C. F. Tse, Yuet Yan Fiona Chan, K. M. Poon, C. Lui
It is a common challenge for emergency physicians to differentiate pneumonia from simple upper respiratory tract infections. Several clinical prediction rules exist to assist the diagnosis process and guide the clinical decisions of ordering investigations such as chest X‐ray (CXR).This study aims to validate and compare the accuracy of various prediction rules in the setting of children and adolescents presenting with acute febrile respiratory illness (AFRI).This was a prospective multicentre study. Three hundred and fifty‐five patients, aged 6–18 years, were recruited. Patients with immunocompromised state or hypoxia were excluded. Pneumonia was defined as diagnosis by CXR or subsequent diagnosis of pneumonia upon re‐attendance within 7 days. Clinical rules including Diehr rule, Heckerling rule, Bilkis simpler rule, the AFRI rule, the paediatric acute febrile respiratory illness rule (PAFRI) were compared in terms of accuracy of predicting pneumonia in the recruited subjects and presented as receiver operating characteristic curves.Five patients were excluded. In the 350 patients included, 38 were diagnosed as pneumonia by CXR and 1 was subsequently diagnosed as pneumonia upon re‐attendance. The area under the receiver operating characteristic curve of Diehr rule, Heckerling rule, Bilkis simpler rule, AFRI rule and PAFRI rule were 0.703, 0.565, 0.59, 0.807 and 0.846 respectively. The PAFRI rule is superior to other prediction rules in terms of diagnostic accuracy. At the cut‐off of PAFRI ≥0, the rule has high sensitivity of 97.44% and negative predictive value of 99.09%.Among the rules compared, the PAFRI rule has the highest diagnostic accuracy in assisting emergency physicians to identify pneumonia among children and adolescents aged 6–18 years presenting with AFRI.
{"title":"Comparing accuracy of clinical prediction rules to predict pneumonia in children and adolescents with acute febrile respiratory illness","authors":"Yuet Hong Wu, Jeremy Ho Hei Chiu, C. F. Tse, Yuet Yan Fiona Chan, K. M. Poon, C. Lui","doi":"10.1002/hkj2.12010","DOIUrl":"https://doi.org/10.1002/hkj2.12010","url":null,"abstract":"It is a common challenge for emergency physicians to differentiate pneumonia from simple upper respiratory tract infections. Several clinical prediction rules exist to assist the diagnosis process and guide the clinical decisions of ordering investigations such as chest X‐ray (CXR).This study aims to validate and compare the accuracy of various prediction rules in the setting of children and adolescents presenting with acute febrile respiratory illness (AFRI).This was a prospective multicentre study. Three hundred and fifty‐five patients, aged 6–18 years, were recruited. Patients with immunocompromised state or hypoxia were excluded. Pneumonia was defined as diagnosis by CXR or subsequent diagnosis of pneumonia upon re‐attendance within 7 days. Clinical rules including Diehr rule, Heckerling rule, Bilkis simpler rule, the AFRI rule, the paediatric acute febrile respiratory illness rule (PAFRI) were compared in terms of accuracy of predicting pneumonia in the recruited subjects and presented as receiver operating characteristic curves.Five patients were excluded. In the 350 patients included, 38 were diagnosed as pneumonia by CXR and 1 was subsequently diagnosed as pneumonia upon re‐attendance. The area under the receiver operating characteristic curve of Diehr rule, Heckerling rule, Bilkis simpler rule, AFRI rule and PAFRI rule were 0.703, 0.565, 0.59, 0.807 and 0.846 respectively. The PAFRI rule is superior to other prediction rules in terms of diagnostic accuracy. At the cut‐off of PAFRI ≥0, the rule has high sensitivity of 97.44% and negative predictive value of 99.09%.Among the rules compared, the PAFRI rule has the highest diagnostic accuracy in assisting emergency physicians to identify pneumonia among children and adolescents aged 6–18 years presenting with AFRI.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140212548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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