Pub Date : 2023-02-12DOI: 10.1177/10249079231153719
R. Lo, L. Lyngholm, M. Brabrand, L. Leung, K. K. Hung, S. Laugesen, S. Posth, T. Cooksley, C. Graham, C. Nickel
Several early warning scores have been designed to optimize acute care by identifying patients at risk of deterioration. In this post hoc dual center study, we analyzed the performance of six clinical scores (the Goodacre score, Groarke, Worthing Physiological Score, Rapid Acute Physiology Score, Rapid Emergency Medicine Score, United Kingdom National Early Warning Score. The primary outcome is 30-day all-cause mortality after inclusion and data were obtained from previous studies performed at two different emergency departments on two continents (Denmark, Europe, and Hong Kong, Asia). We included 2952 people; 1482 (50.2%) were male, mean age (standard deviation) was 65.7 (18.3) years, and 109 (3.7%) died within 30 days. Mortality rate increased steadily with increasing scores for all six scoring systems in Hong Kong while this was less obvious in Denmark. In all patients, Rapid Acute Physiology Score had the lowest discriminatory power while National Early Warning Score had the highest. National Early Warning Score performed best in Hong Kong while Worthing performed marginally better in Denmark. Surprisingly, the performance of the scoring systems varied considerably, but were largely unaffected by location, and none of them performed close to what clinicians would normally require for predicting 30-day all-cause mortality All scores performed similarly across both centers, with poor prediction of 30-day all-cause mortality. Based on these findings, we believe that clinical scores must be supplemented by either biochemical values or global markers of physiological reserve to reflect reality and to be of true value.
{"title":"A tale of two continents: The performance of six early warning scores in two emergency departments","authors":"R. Lo, L. Lyngholm, M. Brabrand, L. Leung, K. K. Hung, S. Laugesen, S. Posth, T. Cooksley, C. Graham, C. Nickel","doi":"10.1177/10249079231153719","DOIUrl":"https://doi.org/10.1177/10249079231153719","url":null,"abstract":"Several early warning scores have been designed to optimize acute care by identifying patients at risk of deterioration. In this post hoc dual center study, we analyzed the performance of six clinical scores (the Goodacre score, Groarke, Worthing Physiological Score, Rapid Acute Physiology Score, Rapid Emergency Medicine Score, United Kingdom National Early Warning Score. The primary outcome is 30-day all-cause mortality after inclusion and data were obtained from previous studies performed at two different emergency departments on two continents (Denmark, Europe, and Hong Kong, Asia). We included 2952 people; 1482 (50.2%) were male, mean age (standard deviation) was 65.7 (18.3) years, and 109 (3.7%) died within 30 days. Mortality rate increased steadily with increasing scores for all six scoring systems in Hong Kong while this was less obvious in Denmark. In all patients, Rapid Acute Physiology Score had the lowest discriminatory power while National Early Warning Score had the highest. National Early Warning Score performed best in Hong Kong while Worthing performed marginally better in Denmark. Surprisingly, the performance of the scoring systems varied considerably, but were largely unaffected by location, and none of them performed close to what clinicians would normally require for predicting 30-day all-cause mortality All scores performed similarly across both centers, with poor prediction of 30-day all-cause mortality. Based on these findings, we believe that clinical scores must be supplemented by either biochemical values or global markers of physiological reserve to reflect reality and to be of true value.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45543391","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 : 2023-02-06DOI: 10.1177/10249079231154241
Y. Chan, M. Tse
{"title":"Clinical toxicology in emergency medicine: 20 Years and beyond","authors":"Y. Chan, M. Tse","doi":"10.1177/10249079231154241","DOIUrl":"https://doi.org/10.1177/10249079231154241","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"71 - 72"},"PeriodicalIF":0.6,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44257132","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 : 2023-01-31DOI: 10.1177/10249079231151518
M. Lau, O. Wong
Early antibiotic administration in sepsis improves patient survival. Treatment with antibiotics should cover potential pathogens and should avoid overusing broad-spectrum antibiotics. We have to identify patients who have high risks of infection with drug-resistant organisms. A retrospective cohort study was conducted to identify potential risk factors associated with bloodstream infections with drug-resistant organisms to help the choice of empirical antibiotics in the emergency department. Adult patients with bloodstream infection diagnosed by blood culture in the emergency department in the period of 1 January 2020 to 31 December 2020 were included. Clinical features including chronic medical illnesses, clinical presentation and severity, and patients’ outcomes were identified in the electronic medical records. Bloodstream infection with drug-resistant organisms is defined as positive blood culture with bacteria resistant to either (1) amoxicillin/ clavulanic acid AND ceftriaxone or (2) amoxicillin/ clavulanic acid or ceftriaxone PLUS amikacin or levofloxacin. Univariate and multivariate analyses were conducted to identify risk factors associated with the study outcome. Among 105 patients with bloodstream infection, 17% were caused by drug-resistant organisms. Multivariate analysis showed that age is a risk factor associated with bloodstream infection with drug-resistant organisms (odds ratio: 1.04, 95% confidence interval: 1.0–1.08, p = 0.03). In conclusion, age is a significant risk factor for drug-resistant bloodstream infection in emergency department patients. Further research may be needed to find out the relationship between frailty and infection with drug-resistant organisms.
{"title":"Risk factors associated with bacteremia with drug-resistant organisms: Review of blood culture results in emergency department of a regional hospital","authors":"M. Lau, O. Wong","doi":"10.1177/10249079231151518","DOIUrl":"https://doi.org/10.1177/10249079231151518","url":null,"abstract":"Early antibiotic administration in sepsis improves patient survival. Treatment with antibiotics should cover potential pathogens and should avoid overusing broad-spectrum antibiotics. We have to identify patients who have high risks of infection with drug-resistant organisms. A retrospective cohort study was conducted to identify potential risk factors associated with bloodstream infections with drug-resistant organisms to help the choice of empirical antibiotics in the emergency department. Adult patients with bloodstream infection diagnosed by blood culture in the emergency department in the period of 1 January 2020 to 31 December 2020 were included. Clinical features including chronic medical illnesses, clinical presentation and severity, and patients’ outcomes were identified in the electronic medical records. Bloodstream infection with drug-resistant organisms is defined as positive blood culture with bacteria resistant to either (1) amoxicillin/ clavulanic acid AND ceftriaxone or (2) amoxicillin/ clavulanic acid or ceftriaxone PLUS amikacin or levofloxacin. Univariate and multivariate analyses were conducted to identify risk factors associated with the study outcome. Among 105 patients with bloodstream infection, 17% were caused by drug-resistant organisms. Multivariate analysis showed that age is a risk factor associated with bloodstream infection with drug-resistant organisms (odds ratio: 1.04, 95% confidence interval: 1.0–1.08, p = 0.03). In conclusion, age is a significant risk factor for drug-resistant bloodstream infection in emergency department patients. Further research may be needed to find out the relationship between frailty and infection with drug-resistant organisms.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45965652","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 : 2022-12-26DOI: 10.1177/10249079221143303
Yat Hei Lo
{"title":"Not as stiff as bamboo","authors":"Yat Hei Lo","doi":"10.1177/10249079221143303","DOIUrl":"https://doi.org/10.1177/10249079221143303","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43519192","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 : 2022-11-29DOI: 10.1177/10249079221140626
H. Ho, K. Hung
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). Hong Kong is a metropolitan vibrant city, connecting the world through our extensive networks, expertise, learning attitude and willingness to participate in matters outside Hong Kong. Within the field of medicine, healthcare professionals of Hong Kong are reputable internationally with health statistics ranking among the best in the world. Local emergency care workers have contributed to the credit for safeguarding health of citizens of Hong Kong. Emergency medicine (EM) is part of the emergency care (EC) spectrum. To ensure a healthy and safe community, EM should reach beyond the boundary of the hospital. International Federation for Emergency Medicine (IFEM) has recently enhanced its vision from ‘fostering the worldwide development of EM as a specialty’ to a wider scope of ‘advocating universal access to high quality emergency medical care around the world’. To achieve that vision, IFEM has three missions:
{"title":"Global connection through the International Federation for Emergency Medicine (IFEM)","authors":"H. Ho, K. Hung","doi":"10.1177/10249079221140626","DOIUrl":"https://doi.org/10.1177/10249079221140626","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). Hong Kong is a metropolitan vibrant city, connecting the world through our extensive networks, expertise, learning attitude and willingness to participate in matters outside Hong Kong. Within the field of medicine, healthcare professionals of Hong Kong are reputable internationally with health statistics ranking among the best in the world. Local emergency care workers have contributed to the credit for safeguarding health of citizens of Hong Kong. Emergency medicine (EM) is part of the emergency care (EC) spectrum. To ensure a healthy and safe community, EM should reach beyond the boundary of the hospital. International Federation for Emergency Medicine (IFEM) has recently enhanced its vision from ‘fostering the worldwide development of EM as a specialty’ to a wider scope of ‘advocating universal access to high quality emergency medical care around the world’. To achieve that vision, IFEM has three missions:","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"3 - 7"},"PeriodicalIF":0.6,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45531392","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 : 2022-11-29DOI: 10.1177/10249079221130828
C. Wong, Yau Tak Ng, K. Ching, Pui Kwan Ha, Chun Yu Leung, Wing Kiu Au, C. Lui, K. Tsui
Background: Ventilator-associated pneumonia is one of the commonest complications encountered in intubated patients: its incidence ranges from 20% to 60%, with higher incidences seen in patients with polytrauma. Ventilator-associated pneumonia can result in poor neurological outcomes upon discharge, longer duration of mechanical ventilation and prolonged intensive care unit stays. The use of systemic antibiotics has been proposed as one method to reduce this complication. However, its effectiveness remains to be determined, and concerns about bacterial resistance hinder its use. This study aims to evaluate the effects of systemic antibiotics on early ventilator-associated pneumonia prevention. Methods: This is a single-centred retrospective cohort study, using data in the local trauma registry from 2015 to 2020. Patients aged ⩾18 years who suffered from injury to the head or trunk and were intubated within 12 h of hospitalization were evaluated for early ventilator-associated pneumonia to determine the effectiveness of systemic antibiotics on the incidence of ventilator-associated pneumonia and to identify other risk factors for ventilator-associated pneumonia in patients suffering from trauma. Result: A total of 250 patients were recruited; 59 of them met the criteria for early onset ventilator-associated pneumonia. Early use of broad-spectrum antibiotics with potent anaerobic coverage was found to be protective for early onset ventilator-associated pneumonia (adjusted odds ratio = 0.228, p = 0.044). Increasing age and severe thoracic or abdominal injury were also found to be strong non-modifiable predictors for the development of early onset ventilator-associated pneumonia. Conclusion: Use of systemic antibiotics with potent anaerobic coverage within 3 h of injury was found to prevent early onset ventilator-associated pneumonia in those intubated within 12 h of injury. However, a large-scale randomized control trial may be needed to further evaluate its benefit and its potential side effects, most notably the risk of antibiotic resistance.
{"title":"Effects of systemic antibiotics in early onset ventilator-associated pneumonia in trauma patients: A single-centre retrospective cohort study","authors":"C. Wong, Yau Tak Ng, K. Ching, Pui Kwan Ha, Chun Yu Leung, Wing Kiu Au, C. Lui, K. Tsui","doi":"10.1177/10249079221130828","DOIUrl":"https://doi.org/10.1177/10249079221130828","url":null,"abstract":"Background: Ventilator-associated pneumonia is one of the commonest complications encountered in intubated patients: its incidence ranges from 20% to 60%, with higher incidences seen in patients with polytrauma. Ventilator-associated pneumonia can result in poor neurological outcomes upon discharge, longer duration of mechanical ventilation and prolonged intensive care unit stays. The use of systemic antibiotics has been proposed as one method to reduce this complication. However, its effectiveness remains to be determined, and concerns about bacterial resistance hinder its use. This study aims to evaluate the effects of systemic antibiotics on early ventilator-associated pneumonia prevention. Methods: This is a single-centred retrospective cohort study, using data in the local trauma registry from 2015 to 2020. Patients aged ⩾18 years who suffered from injury to the head or trunk and were intubated within 12 h of hospitalization were evaluated for early ventilator-associated pneumonia to determine the effectiveness of systemic antibiotics on the incidence of ventilator-associated pneumonia and to identify other risk factors for ventilator-associated pneumonia in patients suffering from trauma. Result: A total of 250 patients were recruited; 59 of them met the criteria for early onset ventilator-associated pneumonia. Early use of broad-spectrum antibiotics with potent anaerobic coverage was found to be protective for early onset ventilator-associated pneumonia (adjusted odds ratio = 0.228, p = 0.044). Increasing age and severe thoracic or abdominal injury were also found to be strong non-modifiable predictors for the development of early onset ventilator-associated pneumonia. Conclusion: Use of systemic antibiotics with potent anaerobic coverage within 3 h of injury was found to prevent early onset ventilator-associated pneumonia in those intubated within 12 h of injury. However, a large-scale randomized control trial may be needed to further evaluate its benefit and its potential side effects, most notably the risk of antibiotic resistance.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"253 - 260"},"PeriodicalIF":0.6,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42486572","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 : 2022-11-29DOI: 10.1177/10249079221141756
B Editor's note: b The I Hong Kong Journal of Emergency Medicine i has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. B Conclusions: b There was an increased odds of delayed intracranial hemorrhage within 90 days in older ED head injured patients prescribed warfarin compared to patients not on anticoagulation. Among patients not anticoagulated, 586 (1.0%) had a delayed intracranial hemorrhage, 54 (1.8%) patients on warfarin, and 78 (1.0%) patients on a direct oral anticoagulant had a delayed intracranial hemorrhage. [Extracted from the article]
{"title":"Reciprocal Abstracts January 2023","authors":"","doi":"10.1177/10249079221141756","DOIUrl":"https://doi.org/10.1177/10249079221141756","url":null,"abstract":"B Editor's note: b The I Hong Kong Journal of Emergency Medicine i has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. B Conclusions: b There was an increased odds of delayed intracranial hemorrhage within 90 days in older ED head injured patients prescribed warfarin compared to patients not on anticoagulation. Among patients not anticoagulated, 586 (1.0%) had a delayed intracranial hemorrhage, 54 (1.8%) patients on warfarin, and 78 (1.0%) patients on a direct oral anticoagulant had a delayed intracranial hemorrhage. [Extracted from the article]","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"65 - 68"},"PeriodicalIF":0.6,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49183362","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 : 2022-11-19DOI: 10.1177/10249079221138205
Chan Suen Wah, Chan Chi Keung, Ng Yau Tak, Lui Chun Tat, Fung Hin Tat
Analgesic poisoning is common in Hong Kong. Analgesics containing salicylate are easily available. Salicylate poisoning may be encountered in the daily practice of the accident and emergency department. The issue of routine salicylate screening was discussed in a number of articles, and the viewpoints of most authors were that routine salicylate screening was unnecessary. The primary outcome is to explore the predictive factors of supratherapeutic peak serum salicylate level (>2.17 mmol/L) and delineate the role of routine screening serum salicylate level in poisoned patients attending the accident and emergency department. This is a retrospective cohort study. Poisoning cases presented to Hong Kong Poison Information Centre between 1 July 2008 and 31 October 2020 with serum salicylate level checked were included. The demographics, laboratory parameters and clinical outcomes were reviewed. There were 8673 cases included with serum salicylate level checked, accounting for 17% of all poisoning cases. Sixty-six (0.76%) cases had supratherapeutic peak serum salicylate level and 11 (0.13%) of them were undeclared salicylate ingestion. Worse clinical outcomes were observed in cases with supratherapeutic peak serum salicylate level. Univariate analysis showed that tinnitus, hyperthermia, alkalaemia, metabolic acidosis, respiratory alkalosis and therapeutic use of aspirin were significantly associated with supratherapeutic peak serum salicylate level. Variables with p < 0.3 were entered into the backward stepwise logistic regression by likelihood ratio. A clinical prediction rule with three attributes (tinnitus, therapeutic use of aspirin and partial pressure of CO2 <5 kPa) was derived. It showed 100% sensitivity in internal validation. Serum salicylate level should be checked in poisoned patients with (1) tinnitus, (2) the therapeutic use of aspirin or (3) partial pressure of CO2 <5 kPa in arterial or venous blood gas. Routine salicylate screening remained a tool for clinicians not experienced in toxicology.
{"title":"Prediction rule of supratherapeutic peak serum salicylate level in poisoning patients attending emergency departments","authors":"Chan Suen Wah, Chan Chi Keung, Ng Yau Tak, Lui Chun Tat, Fung Hin Tat","doi":"10.1177/10249079221138205","DOIUrl":"https://doi.org/10.1177/10249079221138205","url":null,"abstract":"Analgesic poisoning is common in Hong Kong. Analgesics containing salicylate are easily available. Salicylate poisoning may be encountered in the daily practice of the accident and emergency department. The issue of routine salicylate screening was discussed in a number of articles, and the viewpoints of most authors were that routine salicylate screening was unnecessary. The primary outcome is to explore the predictive factors of supratherapeutic peak serum salicylate level (>2.17 mmol/L) and delineate the role of routine screening serum salicylate level in poisoned patients attending the accident and emergency department. This is a retrospective cohort study. Poisoning cases presented to Hong Kong Poison Information Centre between 1 July 2008 and 31 October 2020 with serum salicylate level checked were included. The demographics, laboratory parameters and clinical outcomes were reviewed. There were 8673 cases included with serum salicylate level checked, accounting for 17% of all poisoning cases. Sixty-six (0.76%) cases had supratherapeutic peak serum salicylate level and 11 (0.13%) of them were undeclared salicylate ingestion. Worse clinical outcomes were observed in cases with supratherapeutic peak serum salicylate level. Univariate analysis showed that tinnitus, hyperthermia, alkalaemia, metabolic acidosis, respiratory alkalosis and therapeutic use of aspirin were significantly associated with supratherapeutic peak serum salicylate level. Variables with p < 0.3 were entered into the backward stepwise logistic regression by likelihood ratio. A clinical prediction rule with three attributes (tinnitus, therapeutic use of aspirin and partial pressure of CO2 <5 kPa) was derived. It showed 100% sensitivity in internal validation. Serum salicylate level should be checked in poisoned patients with (1) tinnitus, (2) the therapeutic use of aspirin or (3) partial pressure of CO2 <5 kPa in arterial or venous blood gas. Routine salicylate screening remained a tool for clinicians not experienced in toxicology.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45919080","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 : 2022-10-13DOI: 10.1177/10249079221129030
C. Chan, H. Shum, P. Wu, Nyw Leung, LL Chang, W. Yan
Introduction: In Hong Kong, heat-related illness (HRI) represents an important cause of morbidity and mortality among healthy adults engaging in outdoor activities during summer. It can result in intensive care unit (ICU) admission. This retrospective study aimed to profile critically ill patients with HRI and identify potential risk factors for mortality. Methods: This retrospective case series included adults with HRI from 1 January 2009 to 30 June 2020 admitted to the ICU of Pamela Youde Nethersole Eastern Hospital (PYNEH). Demographics, admission severity, co-morbidities, and laboratory investigations were analysed. Outcome data studied included mortality, ICU length of stay (LOS), ventilator days, and hospital LOS. Results: Among the 38 individuals included, 97% were hikers. About 92.1% of patients survived, while 7.9% expired. The median age of the patients was 48 years, and 78.9% were men. Hypertension was the most frequent concurrent disorder. Most cases were presented during the hot summer months of May (29%), July (24%) and August (18%). The localities’ median peak temperature and humidity were 33.2°C and 88%, respectively. Ninety-two percent of patients were airlifted to the hospital by helicopters. The median peak body temperature was 40.3°C. Central nervous system derangement (Glasgow Coma Scale (GCS) score ⩽ 8) was the top presenting feature (65.7%). About 57.9% of patients required vasopressor support, followed by mechanical ventilation (50%) and renal replacement therapy (31.6%). Conclusions: Most critically ill patients suffering from HRI were hikers and middle-aged adults. Mortality was 7.9% despite advanced life support in ICU. Raising public awareness of the associated risk with hiking in hot summer is essential for the prevention of HRI.
{"title":"Patients with heat-related illness admitted to an intensive care unit in Hong Kong: A single-centre retrospective study (2009–2020)","authors":"C. Chan, H. Shum, P. Wu, Nyw Leung, LL Chang, W. Yan","doi":"10.1177/10249079221129030","DOIUrl":"https://doi.org/10.1177/10249079221129030","url":null,"abstract":"Introduction: In Hong Kong, heat-related illness (HRI) represents an important cause of morbidity and mortality among healthy adults engaging in outdoor activities during summer. It can result in intensive care unit (ICU) admission. This retrospective study aimed to profile critically ill patients with HRI and identify potential risk factors for mortality. Methods: This retrospective case series included adults with HRI from 1 January 2009 to 30 June 2020 admitted to the ICU of Pamela Youde Nethersole Eastern Hospital (PYNEH). Demographics, admission severity, co-morbidities, and laboratory investigations were analysed. Outcome data studied included mortality, ICU length of stay (LOS), ventilator days, and hospital LOS. Results: Among the 38 individuals included, 97% were hikers. About 92.1% of patients survived, while 7.9% expired. The median age of the patients was 48 years, and 78.9% were men. Hypertension was the most frequent concurrent disorder. Most cases were presented during the hot summer months of May (29%), July (24%) and August (18%). The localities’ median peak temperature and humidity were 33.2°C and 88%, respectively. Ninety-two percent of patients were airlifted to the hospital by helicopters. The median peak body temperature was 40.3°C. Central nervous system derangement (Glasgow Coma Scale (GCS) score ⩽ 8) was the top presenting feature (65.7%). About 57.9% of patients required vasopressor support, followed by mechanical ventilation (50%) and renal replacement therapy (31.6%). Conclusions: Most critically ill patients suffering from HRI were hikers and middle-aged adults. Mortality was 7.9% despite advanced life support in ICU. Raising public awareness of the associated risk with hiking in hot summer is essential for the prevention of HRI.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"247 - 252"},"PeriodicalIF":0.6,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47536245","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 : 2022-10-03DOI: 10.1177/10249079221130602
C. S. Dam, Majon Muller
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). Annals of Emergency Medicine
{"title":"Reciprocal Abstracts November 22","authors":"C. S. Dam, Majon Muller","doi":"10.1177/10249079221130602","DOIUrl":"https://doi.org/10.1177/10249079221130602","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). Annals of Emergency Medicine","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"385 - 387"},"PeriodicalIF":0.6,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48418887","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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