Pub Date : 2020-11-24DOI: 10.1177/1024907920972284
K. Karaman, Y. E. Özlüer, Y. Golcuk, M. Avcil
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). To the Editor, We read the article “Implementation of resuscitative endovascular balloon occlusion of the aorta (REBOA) at the Korean Regional Trauma Center” by Park et al.1 with interest. The authors aimed to investigate the feasibility and effectiveness of REBOA based on their experience and shared their implementation process by trauma surgeons in Korea. They found that mean change of systolic blood pressure after REBOA was 41.3 ± 30.2 mm Hg. Finally, they concluded that REBOA is a useful adjunctive skill for trauma surgeons, and a brief training course can help in the implementation of the procedure. REBOA is used as adjunctive management for a profound shock in some trauma centers. The goals of REBOA include the prevention or reversal of hemodynamic collapse by minimizing ongoing bleeding and restoration of adequate perfusion pressure to the heart, lungs, and brain. In a case report published by Özlüer et al.,2 the authors performed intermittent REBOA in the emergency department to a vaginal bleeding patient with class 3 hemorrhagic shock. They reported that there was a serious increase in the systolic blood pressure of the patient after REBOA (from 93 to 125 mm Hg). They also reported that the patient completely recovered and was discharged on the seventh day of admission. In conclusion, REBOA is a useful adjunctive skill either for trauma surgeons or for emergency physicians. However, this procedure can be a lifesaving treatment option not only for trauma patients but also for patients with non-traumatic life-threatening hemorrhage such as vaginal bleeding. In addition, the capacity of short training courses can be expanded to include emergency physicians.
{"title":"REBOA can be performed in the emergency department not only for trauma patients but also for life-threatening vaginal bleeding","authors":"K. Karaman, Y. E. Özlüer, Y. Golcuk, M. Avcil","doi":"10.1177/1024907920972284","DOIUrl":"https://doi.org/10.1177/1024907920972284","url":null,"abstract":"Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). To the Editor, We read the article “Implementation of resuscitative endovascular balloon occlusion of the aorta (REBOA) at the Korean Regional Trauma Center” by Park et al.1 with interest. The authors aimed to investigate the feasibility and effectiveness of REBOA based on their experience and shared their implementation process by trauma surgeons in Korea. They found that mean change of systolic blood pressure after REBOA was 41.3 ± 30.2 mm Hg. Finally, they concluded that REBOA is a useful adjunctive skill for trauma surgeons, and a brief training course can help in the implementation of the procedure. REBOA is used as adjunctive management for a profound shock in some trauma centers. The goals of REBOA include the prevention or reversal of hemodynamic collapse by minimizing ongoing bleeding and restoration of adequate perfusion pressure to the heart, lungs, and brain. In a case report published by Özlüer et al.,2 the authors performed intermittent REBOA in the emergency department to a vaginal bleeding patient with class 3 hemorrhagic shock. They reported that there was a serious increase in the systolic blood pressure of the patient after REBOA (from 93 to 125 mm Hg). They also reported that the patient completely recovered and was discharged on the seventh day of admission. In conclusion, REBOA is a useful adjunctive skill either for trauma surgeons or for emergency physicians. However, this procedure can be a lifesaving treatment option not only for trauma patients but also for patients with non-traumatic life-threatening hemorrhage such as vaginal bleeding. In addition, the capacity of short training courses can be expanded to include emergency physicians.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"64 - 64"},"PeriodicalIF":0.6,"publicationDate":"2020-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920972284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44501545","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}
Pub Date : 2020-11-23DOI: 10.1177/1024907920971159
Vivian Yim, C. M. Ip, A. Siu, L. Leung, K. Hung, C. Graham, P. Song, J. Walline
Background: Hong Kong rates of bystander cardiopulmonary resuscitation are very low by international standards. Several Hong Kong secondary schools have begun incorporating cardiopulmonary resuscitation training into their curriculums for teachers and students. Objective: This study aimed to explore secondary school cardiopulmonary resuscitation programs and better understand school principals’ attitudes toward cardiopulmonary resuscitation training. Methods: A cross-sectional survey was sent to all Hong Kong secondary school principals (public and private, except for special education schools) between December 2017 and March 2018. A self-administered questionnaire of 20 items focusing on school characteristics, details of any in-school cardiopulmonary resuscitation materials or training, attitudes toward teaching cardiopulmonary resuscitation, and any barriers or ways to promote school cardiopulmonary resuscitation training was given to all school principals in the territory. This study was approved by the Survey and Behavioural Research Ethics committee of the Chinese University of Hong Kong on September 13, 2017. Results: Out of the 506 schools contacted, 110 completed surveys were returned (21.7%). Cardiopulmonary resuscitation training was offered in 33.6% (37/110), while 92.7% (102/110) had an automatic external defibrillator. A majority (69.1% (76/110)) agreed or strongly agreed that cardiopulmonary resuscitation training should be compulsory for secondary school students. In schools where cardiopulmonary resuscitation was taught, most cardiopulmonary resuscitation students were aged 15–17 years, and most courses ran for < 5 h. Increased funding could encourage more schools to offer cardiopulmonary resuscitation training to students in the future. Conclusion: One-third (33.6%) of Hong Kong secondary schools offer cardiopulmonary resuscitation training. Increased funding may support school-based cardiopulmonary resuscitation instruction and improve rates of bystander cardiopulmonary resuscitation in the future.
{"title":"Cardiopulmonary resuscitation training in secondary education: A prospective cross-sectional survey of 110 Hong Kong secondary schools","authors":"Vivian Yim, C. M. Ip, A. Siu, L. Leung, K. Hung, C. Graham, P. Song, J. Walline","doi":"10.1177/1024907920971159","DOIUrl":"https://doi.org/10.1177/1024907920971159","url":null,"abstract":"Background: Hong Kong rates of bystander cardiopulmonary resuscitation are very low by international standards. Several Hong Kong secondary schools have begun incorporating cardiopulmonary resuscitation training into their curriculums for teachers and students. Objective: This study aimed to explore secondary school cardiopulmonary resuscitation programs and better understand school principals’ attitudes toward cardiopulmonary resuscitation training. Methods: A cross-sectional survey was sent to all Hong Kong secondary school principals (public and private, except for special education schools) between December 2017 and March 2018. A self-administered questionnaire of 20 items focusing on school characteristics, details of any in-school cardiopulmonary resuscitation materials or training, attitudes toward teaching cardiopulmonary resuscitation, and any barriers or ways to promote school cardiopulmonary resuscitation training was given to all school principals in the territory. This study was approved by the Survey and Behavioural Research Ethics committee of the Chinese University of Hong Kong on September 13, 2017. Results: Out of the 506 schools contacted, 110 completed surveys were returned (21.7%). Cardiopulmonary resuscitation training was offered in 33.6% (37/110), while 92.7% (102/110) had an automatic external defibrillator. A majority (69.1% (76/110)) agreed or strongly agreed that cardiopulmonary resuscitation training should be compulsory for secondary school students. In schools where cardiopulmonary resuscitation was taught, most cardiopulmonary resuscitation students were aged 15–17 years, and most courses ran for < 5 h. Increased funding could encourage more schools to offer cardiopulmonary resuscitation training to students in the future. Conclusion: One-third (33.6%) of Hong Kong secondary schools offer cardiopulmonary resuscitation training. Increased funding may support school-based cardiopulmonary resuscitation instruction and improve rates of bystander cardiopulmonary resuscitation in the future.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"30 - 36"},"PeriodicalIF":0.6,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920971159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716119","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}
Pub Date : 2020-11-23DOI: 10.1177/1024907920972283
M. Gulen, S. Satar, Selen Acehan, Akkan Avcı, Adem Kaya, K. Şener, Cem Isıkber
Background:The treatment of benign paroxysmal positional vertigo (BPPV) has not been well studied. Many clinicians are indifferent about canalith reposition maneuvers and frequently prefer medical ...
{"title":"Benign paroxysmal positional vertigo in emergency department: How to treat?","authors":"M. Gulen, S. Satar, Selen Acehan, Akkan Avcı, Adem Kaya, K. Şener, Cem Isıkber","doi":"10.1177/1024907920972283","DOIUrl":"https://doi.org/10.1177/1024907920972283","url":null,"abstract":"Background:The treatment of benign paroxysmal positional vertigo (BPPV) has not been well studied. Many clinicians are indifferent about canalith reposition maneuvers and frequently prefer medical ...","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"1 1","pages":"102490792097228"},"PeriodicalIF":0.6,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920972283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44692180","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}
Pub Date : 2020-11-18DOI: 10.1177/1024907920971633
K. Cheung, L. Leung
Background: Older people (⩾65 years) present a unique challenge in emergency department triage. Hong Kong’s Hospital Authority adopts a five-level emergency department triage system, with no special considerations for older people. We evaluated the validity and reliability of this triage scale in older people in a regional Hong Kong emergency department. Methods: In total, 295 cases stratified by triage category were randomly selected for review from November 2016 to January 2017. Validity was established by comparing the real emergency department patients’ triage category against (1) that of an expert panel and (2) the need for life-saving intervention. Triage notes were extracted to make case scenarios to evaluate inter- and intra-rater reliabilities. Emergency department nurses (n = 8) were randomly selected and grouped into <5 and ⩾5 years emergency department experience. All nurses independently rated all 295 scenarios, blinded to clinical outcomes. Results: The percentage agreement between the real emergency department patients’ triage category and the expert panel’s assignment was 68.5%, with 16.3% and 15.3% over-triage and under-triage, respectively. Quadratic weighting kappa for agreement with the expert panel was 0.72 (95% confidence interval: 0.53–0.91). The sensitivity, specificity and positive likelihood ratio for the need for life-saving interventions were 75.0% (95% confidence interval: 47.6%–92.7%), 97.1% (95% confidence interval: 94.4%–98.8%) and 26.2 (95% confidence interval: 12.5%–54.8%), respectively. The Fleiss kappa value for inter-rater reliability was 0.50 (95% confidence interval: 0.47–0.54) for junior and senior nurse groups, respectively. Conclusion: The current triage scale demonstrates reasonable validity and reliability for use in our older people. Considerations highlighting the unique characteristics of older people emergency department presentations are recommended.
{"title":"Validity and reliability of the triage scale in older people in a regional emergency department in Hong Kong","authors":"K. Cheung, L. Leung","doi":"10.1177/1024907920971633","DOIUrl":"https://doi.org/10.1177/1024907920971633","url":null,"abstract":"Background: Older people (⩾65 years) present a unique challenge in emergency department triage. Hong Kong’s Hospital Authority adopts a five-level emergency department triage system, with no special considerations for older people. We evaluated the validity and reliability of this triage scale in older people in a regional Hong Kong emergency department. Methods: In total, 295 cases stratified by triage category were randomly selected for review from November 2016 to January 2017. Validity was established by comparing the real emergency department patients’ triage category against (1) that of an expert panel and (2) the need for life-saving intervention. Triage notes were extracted to make case scenarios to evaluate inter- and intra-rater reliabilities. Emergency department nurses (n = 8) were randomly selected and grouped into <5 and ⩾5 years emergency department experience. All nurses independently rated all 295 scenarios, blinded to clinical outcomes. Results: The percentage agreement between the real emergency department patients’ triage category and the expert panel’s assignment was 68.5%, with 16.3% and 15.3% over-triage and under-triage, respectively. Quadratic weighting kappa for agreement with the expert panel was 0.72 (95% confidence interval: 0.53–0.91). The sensitivity, specificity and positive likelihood ratio for the need for life-saving interventions were 75.0% (95% confidence interval: 47.6%–92.7%), 97.1% (95% confidence interval: 94.4%–98.8%) and 26.2 (95% confidence interval: 12.5%–54.8%), respectively. The Fleiss kappa value for inter-rater reliability was 0.50 (95% confidence interval: 0.47–0.54) for junior and senior nurse groups, respectively. Conclusion: The current triage scale demonstrates reasonable validity and reliability for use in our older people. Considerations highlighting the unique characteristics of older people emergency department presentations are recommended.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"65 - 71"},"PeriodicalIF":0.6,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920971633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44581962","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}
Introduction: Acute carbon monoxide (CO) poisoning could lead to headache, dizziness, myocardial injury, neurological sequela, and death. Sudden hearing loss is a rare symptom of acute CO poisoning. Case Presentation: Here, we report a case of a 42-year-old woman who suffered from acute hearing loss after exposure to a suicidal environment of high concentration of CO. Partial recovery of hearing was demonstrated after a combination of corticosteroid and hyperbaric oxygen therapy was given. Discussion: The mechanism of sudden hearing loss caused by acute CO poisoning is not well-established. It is believed to be related with the hypoxic damage to the cochlea. The characteristic of sudden hearing loss caused by acute CO poisoning is that it often affects in high frequency bilaterally. Conclusion: This report would prompt the clinician in early recognition of this sudden hearing loss of uncommon etiology.
{"title":"Sudden hearing loss following acute carbon monoxide poisoning: A case report and literature review","authors":"Chiao-Zhu Li, Chiao-Ching Li, Meng-Chi Lin, Wei-Shih Tseng","doi":"10.1177/1024907920969306","DOIUrl":"https://doi.org/10.1177/1024907920969306","url":null,"abstract":"Introduction: Acute carbon monoxide (CO) poisoning could lead to headache, dizziness, myocardial injury, neurological sequela, and death. Sudden hearing loss is a rare symptom of acute CO poisoning. Case Presentation: Here, we report a case of a 42-year-old woman who suffered from acute hearing loss after exposure to a suicidal environment of high concentration of CO. Partial recovery of hearing was demonstrated after a combination of corticosteroid and hyperbaric oxygen therapy was given. Discussion: The mechanism of sudden hearing loss caused by acute CO poisoning is not well-established. It is believed to be related with the hypoxic damage to the cochlea. The characteristic of sudden hearing loss caused by acute CO poisoning is that it often affects in high frequency bilaterally. Conclusion: This report would prompt the clinician in early recognition of this sudden hearing loss of uncommon etiology.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"9S - 13S"},"PeriodicalIF":0.6,"publicationDate":"2020-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920969306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43396272","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}
Pub Date : 2020-11-03DOI: 10.1177/1024907920969326
Ruiting Li, Hong Liu, Hong Qi, Yin Yuan, X. Zou, Haiyan Huang, Jiaojiao Wan, Z. Lv, Yaqi Ouyang, Shangwen Pan, Xin Zhao, Hua-qing Shu, Y. Shang
Background: An outbreak of coronavirus disease 2019 (COVID-19) took place in Wuhan, China, by the end of 2019, and the disease continues to spread all over the world. The number of patients is increasing rapidly, a large number of infected patients is critically ill, and the mortality is high. However, information on COVID-19 patients is limited, and its clinical characteristics have not been fully studied. Objectives: To compare the performances of point-of-care lung ultrasound (LUS) and bedside chest X-ray in assessing the condition of COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods: This observational study enrolled 42 COVID-19 patients with ARDS who were admitted to the Department of Critical Care Medicine of the Wuhan Union Hospital from February to April 2020. The point-of-care LUS characteristics of the COVID-19 patients with ARDS were summarized, and the performances of LUS and bedside chest X-ray in assessing the patient’s condition were compared. Results: Most of the 42 patients were elderly individuals with chronic clinical diseases. The proportion of patients older than 60 years old was 85.7%. All patients were given invasive mechanical ventilation; eight (19.0%) of them received venovenous extracorporeal membrane oxygenation support. LUS has evident advantages in detecting lung consolidation, patchy shadows, and pleural thickening, and pleural line changes in particular. The receiver operating characteristic analysis indicated that the sensitivity, Youden index, and kappa value for detecting COVID-19 patients with ARDS were higher for LUS than the chest X-ray. Conclusion: LUS has better diagnostic accuracy and sensitivity in COVID-19 patients with ARDS than the chest X-ray.
{"title":"Lung ultrasound assessment of acute respiratory distress syndrome caused by coronavirus disease 2019: An observational study","authors":"Ruiting Li, Hong Liu, Hong Qi, Yin Yuan, X. Zou, Haiyan Huang, Jiaojiao Wan, Z. Lv, Yaqi Ouyang, Shangwen Pan, Xin Zhao, Hua-qing Shu, Y. Shang","doi":"10.1177/1024907920969326","DOIUrl":"https://doi.org/10.1177/1024907920969326","url":null,"abstract":"Background: An outbreak of coronavirus disease 2019 (COVID-19) took place in Wuhan, China, by the end of 2019, and the disease continues to spread all over the world. The number of patients is increasing rapidly, a large number of infected patients is critically ill, and the mortality is high. However, information on COVID-19 patients is limited, and its clinical characteristics have not been fully studied. Objectives: To compare the performances of point-of-care lung ultrasound (LUS) and bedside chest X-ray in assessing the condition of COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods: This observational study enrolled 42 COVID-19 patients with ARDS who were admitted to the Department of Critical Care Medicine of the Wuhan Union Hospital from February to April 2020. The point-of-care LUS characteristics of the COVID-19 patients with ARDS were summarized, and the performances of LUS and bedside chest X-ray in assessing the patient’s condition were compared. Results: Most of the 42 patients were elderly individuals with chronic clinical diseases. The proportion of patients older than 60 years old was 85.7%. All patients were given invasive mechanical ventilation; eight (19.0%) of them received venovenous extracorporeal membrane oxygenation support. LUS has evident advantages in detecting lung consolidation, patchy shadows, and pleural thickening, and pleural line changes in particular. The receiver operating characteristic analysis indicated that the sensitivity, Youden index, and kappa value for detecting COVID-19 patients with ARDS were higher for LUS than the chest X-ray. Conclusion: LUS has better diagnostic accuracy and sensitivity in COVID-19 patients with ARDS than the chest X-ray.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"8 - 14"},"PeriodicalIF":0.6,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920969326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48233562","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}
Pub Date : 2020-11-01DOI: 10.1177/1024907919896451
{"title":"Corrigendum to Radiological features of body packers: An experience from a regional accident and emergency department in close proximity to the Hong Kong International Airport","authors":"","doi":"10.1177/1024907919896451","DOIUrl":"https://doi.org/10.1177/1024907919896451","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"27 1","pages":"384 - 384"},"PeriodicalIF":0.6,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907919896451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43481426","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}
Pub Date : 2020-11-01DOI: 10.1177/1024907920942990
{"title":"Corrigendum to Hyperglycaemia as a Positive Predictor of Mortality in Major Trauma","authors":"","doi":"10.1177/1024907920942990","DOIUrl":"https://doi.org/10.1177/1024907920942990","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"27 1","pages":"385 - 385"},"PeriodicalIF":0.6,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920942990","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42764010","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}
Pub Date : 2020-10-28DOI: 10.1177/1024907920968648
F. Çengel, O. Gurkan, M. Çalık, Mustafa Asım Demirkol, E. Sargin Altunok, Mehmet Fatih Kaya, Sebahat Nacar Doğan
Background: Effective triage and early detection are very important for the control and treatment of coronavirus disease 2019. For this purpose, reverse transcription polymerase chain reaction and chest computed tomography are used in emergency departments. Objective: The aim of the study was to examine the diagnostic performance of computed tomography and to compare the inter-observer agreement among radiologists and between clinicians, in a coronavirus disease 2019 pneumonia high-prevalence area. Methods: After exclusions, 534 patients were retrospectively included in this study. Reverse transcription polymerase chain reaction was considered as gold standard for diagnosis. All computed tomography images were independently reviewed by two radiologists who were blinded to reverse transcription polymerase chain reaction results and other clinical information. Each computed tomography scan was scored in four categories as typical, intermediate, atypical, and negative, regarding coronavirus disease 2019 pneumonia according to Radiological Society of North America guideline. As for the evaluation of the diagnostic performance, typical and intermediate appearances were accepted as positive for coronavirus disease 2019. In addition, the computed tomography scans were scored by two clinicians as coronavirus disease 2019 positive and negative. Results: The study group included 534 patients after the exclusion criteria. As a result of the repeated reverse transcription polymerase chain reaction tests, 396 (74%) patients were diagnosed with coronavirus disease 2019, 138 (26%) patients had a negative result and were evaluated as a control group. When the reverse transcription polymerase chain reaction results were referenced as the gold standard; the accuracy rates of radiologists and clinicians (R1, R2, C1, and C2) in the diagnosis of coronavirus disease 2019 were 78%, 79%, 73%, and 71%, their sensitivity rates were 83%, 83%, 74%, and 75%, and the negative predictive values were 57%, 58%, 49%, and 46%, respectively. Inter-observer agreements among the reviewers ranged from good to excellent. Conclusions: Radiological Society of North America guideline related to coronavirus disease 2019 has excellent inter-observer agreement among chest radiologists. In this study, radiologists and clinicians have presented similar and good diagnostic performances in the evaluation of coronavirus disease 2019–suspected patients with chest computed tomography in high-epidemic area.
{"title":"Diagnosis of the coronavirus disease 2019 with chest computed tomography: A retrospective inter-observer agreement study between radiologists and clinicians","authors":"F. Çengel, O. Gurkan, M. Çalık, Mustafa Asım Demirkol, E. Sargin Altunok, Mehmet Fatih Kaya, Sebahat Nacar Doğan","doi":"10.1177/1024907920968648","DOIUrl":"https://doi.org/10.1177/1024907920968648","url":null,"abstract":"Background: Effective triage and early detection are very important for the control and treatment of coronavirus disease 2019. For this purpose, reverse transcription polymerase chain reaction and chest computed tomography are used in emergency departments. Objective: The aim of the study was to examine the diagnostic performance of computed tomography and to compare the inter-observer agreement among radiologists and between clinicians, in a coronavirus disease 2019 pneumonia high-prevalence area. Methods: After exclusions, 534 patients were retrospectively included in this study. Reverse transcription polymerase chain reaction was considered as gold standard for diagnosis. All computed tomography images were independently reviewed by two radiologists who were blinded to reverse transcription polymerase chain reaction results and other clinical information. Each computed tomography scan was scored in four categories as typical, intermediate, atypical, and negative, regarding coronavirus disease 2019 pneumonia according to Radiological Society of North America guideline. As for the evaluation of the diagnostic performance, typical and intermediate appearances were accepted as positive for coronavirus disease 2019. In addition, the computed tomography scans were scored by two clinicians as coronavirus disease 2019 positive and negative. Results: The study group included 534 patients after the exclusion criteria. As a result of the repeated reverse transcription polymerase chain reaction tests, 396 (74%) patients were diagnosed with coronavirus disease 2019, 138 (26%) patients had a negative result and were evaluated as a control group. When the reverse transcription polymerase chain reaction results were referenced as the gold standard; the accuracy rates of radiologists and clinicians (R1, R2, C1, and C2) in the diagnosis of coronavirus disease 2019 were 78%, 79%, 73%, and 71%, their sensitivity rates were 83%, 83%, 74%, and 75%, and the negative predictive values were 57%, 58%, 49%, and 46%, respectively. Inter-observer agreements among the reviewers ranged from good to excellent. Conclusions: Radiological Society of North America guideline related to coronavirus disease 2019 has excellent inter-observer agreement among chest radiologists. In this study, radiologists and clinicians have presented similar and good diagnostic performances in the evaluation of coronavirus disease 2019–suspected patients with chest computed tomography in high-epidemic area.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"15 - 21"},"PeriodicalIF":0.6,"publicationDate":"2020-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920968648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45888347","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}
Pub Date : 2020-10-27DOI: 10.1177/1024907920966520
A. Laurentius, R. Ariani
Introduction: Acute pulmonary embolism is the leading cause of cardiovascular mortality in which only 7% of total suspected cases were correctly diagnosed. Prompt diagnosis is essential to reduce disease burden. 12-lead electrocardiography has become standard of examination in any acute cardiovascular setting. Several abnormalities associated with right ventricular dysfunction include the classic McGinn-White and anterior leads T-wave inversion pattern due to conduction abnormalities. Nevertheless, studies conducting research in evaluating diagnostic values of both patterns have not come to definite conclusion. This review evaluates the diagnostic value of T-wave inversions in anterior leads difference compared to that of McGinn-White sign in patients with suspected acute pulmonary embolism. Methods: Literature searching was conducted from medical databases. Inclusion-exclusion criteria and study eligibility were assessed to select the included studies in this systematic review. Three final articles were selected and critically appraised using the Oxford Center of Evidence-Based Medicine appraisal tools for diagnostic study. Results: Considering the compared importance of selected studies, T-wave inversion shows better specificity (90.9% vs 88.7%) and sensitivity (35.5% vs 28.9%) although both signs exhibit minor impact in terms of sensitivity index. Analyses suggest higher averaged accuracy (accuracy index) and Youden index found in T-wave inversion than that of McGinn-White sign (accuracy index: 57.97% vs 56.16%; Youden index: 0.16 vs 0.12), providing more meaningful diagnostic value. Furthermore, anterior leads T-wave inversion possesses better diagnostic odds ratio than that of McGinn-White sign (5.52 vs 3.17). Conclusion: Anterior lead T-wave inversions present better diagnostic value than that of classic pattern of McGinn-White sign in electrocardiographic presentation of suspected acute pulmonary embolism.
引言：急性肺栓塞是心血管死亡的主要原因，只有7%的疑似病例得到了正确诊断。及时诊断对于减轻疾病负担至关重要。12导联心电图已经成为任何急性心血管环境下的标准检查。与右心室功能障碍相关的几种异常包括典型的McGinn-White和由于传导异常引起的前导联T波倒置模式。然而，对评估这两种模式的诊断价值进行研究的研究尚未得出确切结论。这篇综述评估了前导联T波倒置与McGinn-White征在疑似急性肺栓塞患者中的诊断价值。方法：从医学数据库中进行文献检索。评估纳入-排除标准和研究资格，以选择本系统综述中的纳入研究。最后选择了三篇文章，并使用牛津循证医学中心的诊断研究评估工具进行了批判性评估。结果：考虑到所选研究的相对重要性，T波倒置显示出更好的特异性（90.9%vs 88.7%）和敏感性（35.5%vs 28.9%），尽管这两种迹象在敏感性指数方面都表现出较小的影响。分析表明，T波倒置的平均准确度（准确度指数）和Youden指数高于McGinn-White征（准确度指标：57.97%vs 56.16%；Youden指数：0.16 vs 0.12），提供了更有意义的诊断价值。结论：前导联T波倒置对可疑急性肺栓塞心电图表现的诊断价值优于经典模式的McGinn-White征（5.52 vs 3.17）。
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