Pub Date : 2022-04-19DOI: 10.1177/10249079221092897
J. Giamello, R. Melchio, L. Bertolaccini, P. Caraccio, C. Rendina, G. Lauria
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). Dear Editor, We read with great interest the editorial by Lim, Balsari and Hung recently published on Hong Kong Journal of Emergency Medicine.1 We do agree with the authors as they state that emergency physicians play a major role in preparing the communities for the challenges related to the climate change. In particular, we believe that emergency departments (EDs) offer a unique point of view on the health need of the population; moreover, the correlation between climatic factors and daily ED visits may represent a good model to understand the impact of climate on human morbidity.2 Thus, we conducted the analyses to determine the relationship between climatic factors and ED visits; we performed a retrospective study at the Santa Croce e Carle teaching hub hospital in Cuneo, north-west of Italy, over a 2-year period (1 January 2018 to 31 December 2020). Adults presenting to the ED for several pathologies were included. Data on mean barometric pressure, temperature and rain or snow were collected daily from a weather station located 1 km from the hospital. The relationship of daily or between-day (interday) changes in climatic factors and ED visits was evaluated using time series analysis. In the studied period, there were 151,787 total ED visits; here, we report all the correlations with a statistical significance (i.e. p ⩽ 0.05). Negative interday difference in barometric pressure, lower values of barometric pressure and lower temperature were associated with a decrease in daily ED accesses; in addition, we observed fewer ED accesses during rainy or snowy days. Lower temperature and negative variations in barometric pressure were associated with more ED admissions for respiratory diseases (asthma and chronic obstructive pulmonary disease exacerbations and pneumonia). Besides, we observed a positive correlation between barometric pressure differences and presentations for stroke; finally, lower values of barometric pressure were associated with a greater number of visits for psychiatric disorders. In conclusion, we can state that a correlation between weather factors and ED visits exists; this correlation is particularly strong for respiratory diseases. In the editorial’s conclusion, Lim and colleagues wonder if Emergency Medicine is ready to face the greatest challenge of our times. We believe that an important step is rising awareness among the society that climate is a fundamental determinant of health; fully understanding the interaction between climate and human morbidity may represent a way for copin
知识共享非商业CC BY-NC：本文根据知识共享归因非商业4.0许可条款分发(http://www.creativecommons.org/licenses/by-nc/4.0/)允许对作品进行非商业性使用、复制和分发，而无需进一步许可，前提是原始作品的归属符合SAGE和开放获取页面的规定(https://us.sagepub.com/en-us/nam/open-access-at-sage)。尊敬的编辑，我们饶有兴趣地阅读了Lim、Balsari和Hung最近发表在《香港急诊医学杂志》上的社论。1我们同意作者的观点，因为他们表示，急诊医生在为社区应对气候变化相关挑战做好准备方面发挥着重要作用。特别是，我们认为急诊科对人们的健康需求有着独特的看法；此外，气候因素与每日急诊就诊的相关性可能是了解气候对人类发病率影响的一个很好的模型。2因此，我们进行了分析，以确定气候因素与急诊就诊之间的关系；我们在意大利西北部库内奥的Santa Croce e Carle教学中心医院进行了为期2年（2018年1月1日至2020年12月31日）的回顾性研究。包括因多种病理向急诊科就诊的成年人。每天从距离医院1公里的气象站收集平均气压、温度和雨雪数据。使用时间序列分析来评估气候因素的每日或日间（日间）变化与ED就诊的关系。在研究期间，共有151787次急诊就诊；在这里，我们报告了所有具有统计学意义的相关性（即p⩽0.05）。大气压的负日差、较低的大气压值和较低的温度与每日ED访问量的减少有关；此外，我们在雨天或雪天观察到ED访问次数减少。较低的温度和气压的负变化与呼吸系统疾病（哮喘和慢性阻塞性肺病恶化和肺炎）的ED入院人数增加有关。此外，我们观察到大气压差与中风表现之间呈正相关；最后，气压值越低，精神疾病就诊次数越多。总之，我们可以指出，天气因素与急诊就诊之间存在相关性；这种相关性对于呼吸系统疾病尤其强烈。在社论的结论中，林和同事们想知道急诊医学是否准备好面对我们时代的最大挑战。我们认为，重要的一步是提高社会对气候是健康的根本决定因素的认识；充分了解气候与人类发病率之间的相互作用可能是应对气候变化的一种方法。
{"title":"Climatic factors influence on emergency department visits","authors":"J. Giamello, R. Melchio, L. Bertolaccini, P. Caraccio, C. Rendina, G. Lauria","doi":"10.1177/10249079221092897","DOIUrl":"https://doi.org/10.1177/10249079221092897","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). Dear Editor, We read with great interest the editorial by Lim, Balsari and Hung recently published on Hong Kong Journal of Emergency Medicine.1 We do agree with the authors as they state that emergency physicians play a major role in preparing the communities for the challenges related to the climate change. In particular, we believe that emergency departments (EDs) offer a unique point of view on the health need of the population; moreover, the correlation between climatic factors and daily ED visits may represent a good model to understand the impact of climate on human morbidity.2 Thus, we conducted the analyses to determine the relationship between climatic factors and ED visits; we performed a retrospective study at the Santa Croce e Carle teaching hub hospital in Cuneo, north-west of Italy, over a 2-year period (1 January 2018 to 31 December 2020). Adults presenting to the ED for several pathologies were included. Data on mean barometric pressure, temperature and rain or snow were collected daily from a weather station located 1 km from the hospital. The relationship of daily or between-day (interday) changes in climatic factors and ED visits was evaluated using time series analysis. In the studied period, there were 151,787 total ED visits; here, we report all the correlations with a statistical significance (i.e. p ⩽ 0.05). Negative interday difference in barometric pressure, lower values of barometric pressure and lower temperature were associated with a decrease in daily ED accesses; in addition, we observed fewer ED accesses during rainy or snowy days. Lower temperature and negative variations in barometric pressure were associated with more ED admissions for respiratory diseases (asthma and chronic obstructive pulmonary disease exacerbations and pneumonia). Besides, we observed a positive correlation between barometric pressure differences and presentations for stroke; finally, lower values of barometric pressure were associated with a greater number of visits for psychiatric disorders. In conclusion, we can state that a correlation between weather factors and ED visits exists; this correlation is particularly strong for respiratory diseases. In the editorial’s conclusion, Lim and colleagues wonder if Emergency Medicine is ready to face the greatest challenge of our times. We believe that an important step is rising awareness among the society that climate is a fundamental determinant of health; fully understanding the interaction between climate and human morbidity may represent a way for copin","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46900916","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 : 2022-03-28DOI: 10.1177/10249079221087799
Mina Lee, B. Yu, G. Lee, Jungnam Lee, Kang-Ju Choi, Youngeun Park, Jihun Gwak, Myung-Jin Jang
Background: Trauma center and multidisciplinary management protocols have been proven to improve the outcomes of severely injured patients. Hemorrhage from pelvic injury is associated with high mortality and is a common cause of preventable trauma death. This study aimed to evaluate the effects of the establishment of a trauma center and management protocols on the outcomes of hemodynamically unstable patients with pelvic fractures. Methods: Hemodynamically unstable patients with pelvic fractures were reviewed retrospectively over a 10-year period. They were grouped into the pre-phase and post-phase, which were defined as before and after the establishment of a trauma center and protocols, respectively. Basic characteristics and outcomes were compared between periods. Results: This study enrolled a total of 106 patients. Basic and physiological characteristics were not significantly different in both phases. Pre-peritoneal packing and resuscitative endovascular balloon occlusion of aorta were only performed in the post-phase (pre-peritoneal packing, N = 27; resuscitative endovascular balloon occlusion of aorta, N = 10). In the post-phase, the time from emergency department arrival to hemostatic intervention was significantly shorter (269 ± 132.4 min vs 147.2 ± 95.5 min, p < 0.0001), and mortality due to acute hemorrhage was significantly lower (p = 0.003; absolute risk reduction: 0.22; relative risk reduction: 0.72). Multivariate logistic regression analysis identified age, injury severity score, and the pre-phase as independent risk factors for mortality. Conclusion: The establishment of a trauma center and multidisciplinary management protocols, such as pre-peritoneal packing and resuscitative endovascular balloon occlusion of aorta, improved the outcomes of hemodynamically unstable patients with pelvic fractures.
{"title":"Positive impact of trauma center to exsanguinating pelvic bone fracture patient survival: A Korean trauma center study","authors":"Mina Lee, B. Yu, G. Lee, Jungnam Lee, Kang-Ju Choi, Youngeun Park, Jihun Gwak, Myung-Jin Jang","doi":"10.1177/10249079221087799","DOIUrl":"https://doi.org/10.1177/10249079221087799","url":null,"abstract":"Background: Trauma center and multidisciplinary management protocols have been proven to improve the outcomes of severely injured patients. Hemorrhage from pelvic injury is associated with high mortality and is a common cause of preventable trauma death. This study aimed to evaluate the effects of the establishment of a trauma center and management protocols on the outcomes of hemodynamically unstable patients with pelvic fractures. Methods: Hemodynamically unstable patients with pelvic fractures were reviewed retrospectively over a 10-year period. They were grouped into the pre-phase and post-phase, which were defined as before and after the establishment of a trauma center and protocols, respectively. Basic characteristics and outcomes were compared between periods. Results: This study enrolled a total of 106 patients. Basic and physiological characteristics were not significantly different in both phases. Pre-peritoneal packing and resuscitative endovascular balloon occlusion of aorta were only performed in the post-phase (pre-peritoneal packing, N = 27; resuscitative endovascular balloon occlusion of aorta, N = 10). In the post-phase, the time from emergency department arrival to hemostatic intervention was significantly shorter (269 ± 132.4 min vs 147.2 ± 95.5 min, p < 0.0001), and mortality due to acute hemorrhage was significantly lower (p = 0.003; absolute risk reduction: 0.22; relative risk reduction: 0.72). Multivariate logistic regression analysis identified age, injury severity score, and the pre-phase as independent risk factors for mortality. Conclusion: The establishment of a trauma center and multidisciplinary management protocols, such as pre-peritoneal packing and resuscitative endovascular balloon occlusion of aorta, improved the outcomes of hemodynamically unstable patients with pelvic fractures.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46337450","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 : 2022-03-22DOI: 10.1177/10249079221086708
K. Hung, R. P. Lam, M. Tsui
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). Even though the COVID-19 pandemic has affected every corner of the world, disparity exists among different regions in Asia. The World Health Organization (WHO) statistics showed that South East Asia and Western Pacific ranked third and fourth in terms of the number of cumulative cases as of 24th February 2022.1 In parallel, Western Pacific region has the highest population vaccination rate with 81 persons fully vaccinated per 100 population.1 Thanks to the prompt public health measures, emergency departments (EDs) in Hong Kong have seen relatively fewer COVID-19 patients compared with neighbouring regions.2 The fear of contracting the infection has caused a significant drop in ED attendance during periods of high COVID-19 caseload. In a local survey, 25% of the citizens reported that they would avoid visiting hospital EDs during the pandemic.3 COVID-19 has also caused health service disruptions to people in need of healthcare, including patients with chronic diseases.4 At the time of writing, Hong Kong is currently faced with the largest community outbreak of COVID-19 since the pandemic began. It is commonly agreed that ED staff safety and morale are the top priorities in well functioning EDs. During the pandemic, emergency healthcare workers, especially nurses, have a high rate of burnout. Zakaria et al.5 found the frequent exposure to an angry public, increase in workload, long working hours, dynamic work conditions (including frequent change of guidelines and management approach), and perceived underpayment are factors leading to burnout during COVID-19 in Malaysia. A survey conducted by Wong et al.6 in four public EDs in Hong Kong showed that ED healthcare professionals who had a higher level of self-reported resilience had better compassion satisfaction and lower levels of secondary traumatic stress and burnout, highlighting the importance of fostering resilience among ED staff. The pandemic is also known to impact on psychological health in our everyday lives.7 Protecting and ensuring the wellbeing of ED staff are more important than ever. Combating COVID-19 at the frontline, ED staff have to be vigilant in screening for potential cases, often with a limited battery of diagnostic tests especially early in the pandemic. Asymptomatic cases put additional pressure on the frontline staff. Screening criteria based on fever, travel history, occupation, contact history, and cluster of symptoms (FTOCC) remain the cornerstone in most EDs. Lin et al.8 demonstrated that a travel history alert at the ED that link
{"title":"Emergency medicine during COVID-19: Global challenges and Asian solutions","authors":"K. Hung, R. P. Lam, M. Tsui","doi":"10.1177/10249079221086708","DOIUrl":"https://doi.org/10.1177/10249079221086708","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). Even though the COVID-19 pandemic has affected every corner of the world, disparity exists among different regions in Asia. The World Health Organization (WHO) statistics showed that South East Asia and Western Pacific ranked third and fourth in terms of the number of cumulative cases as of 24th February 2022.1 In parallel, Western Pacific region has the highest population vaccination rate with 81 persons fully vaccinated per 100 population.1 Thanks to the prompt public health measures, emergency departments (EDs) in Hong Kong have seen relatively fewer COVID-19 patients compared with neighbouring regions.2 The fear of contracting the infection has caused a significant drop in ED attendance during periods of high COVID-19 caseload. In a local survey, 25% of the citizens reported that they would avoid visiting hospital EDs during the pandemic.3 COVID-19 has also caused health service disruptions to people in need of healthcare, including patients with chronic diseases.4 At the time of writing, Hong Kong is currently faced with the largest community outbreak of COVID-19 since the pandemic began. It is commonly agreed that ED staff safety and morale are the top priorities in well functioning EDs. During the pandemic, emergency healthcare workers, especially nurses, have a high rate of burnout. Zakaria et al.5 found the frequent exposure to an angry public, increase in workload, long working hours, dynamic work conditions (including frequent change of guidelines and management approach), and perceived underpayment are factors leading to burnout during COVID-19 in Malaysia. A survey conducted by Wong et al.6 in four public EDs in Hong Kong showed that ED healthcare professionals who had a higher level of self-reported resilience had better compassion satisfaction and lower levels of secondary traumatic stress and burnout, highlighting the importance of fostering resilience among ED staff. The pandemic is also known to impact on psychological health in our everyday lives.7 Protecting and ensuring the wellbeing of ED staff are more important than ever. Combating COVID-19 at the frontline, ED staff have to be vigilant in screening for potential cases, often with a limited battery of diagnostic tests especially early in the pandemic. Asymptomatic cases put additional pressure on the frontline staff. Screening criteria based on fever, travel history, occupation, contact history, and cluster of symptoms (FTOCC) remain the cornerstone in most EDs. Lin et al.8 demonstrated that a travel history alert at the ED that link","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45877612","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 : 2022-03-22DOI: 10.1177/10249079221087800
Wai Hung Yeung, Kit Shing Wong John, K. Tsui, Shing Kit Lam Tommy, C. Lui, C. Lau
Objective: The objective of this study was to determine the impact of adding selected mechanism of injury (MOI) to the existing trauma diversion criteria adopted in Hong Kong. Method: This is a cross-sectional study based on the trauma registry of New Territory West Cluster (NTWC) of Hospital Authority from January 2017 to December 2019. All adult patients aged 18 years or above were recruited if their injury occurred in the catchment area of Pok Oi Hospital (POH) or Tin Shui Wai Hospital (TSWH). Performance of the protocol before and after MOI criteria being added in terms of over-diversion and under-diversion rate was determined. Model discrimination was evaluated by plotting the receiver operating characteristic curve, and the area under the curve was compared before and after MOI criteria added. Net reclassification improvement and integrated discrimination improvement indices were evaluated. Result: A total of 502 patients were included for analysis. Before MOI criteria were added, the over-diversion rate and under-diversion rate were 31.1% and 54.7%, respectively. After MOI criteria were added, the over-diversion rate and under-diversion rate were 33.1% and 34.3%, respectively. The receiver operating characteristic curve of current primary trauma diversion (PTD) criteria had an area under the curve of 66.9% (95% confidence interval: 63%–71%). After adding MOI criteria, the new receiver operating characteristic curve yielded an area under the curve of 73.7% (95% confidence interval: 70%–78%), which is significantly better (p < 0.001). Net reclassification improvement and integrated discrimination improvement indices indicated that including MOI criteria would improve the model prediction. Conclusion: Adding mechanism of injury can improve trauma diversion protocol performance.
{"title":"Can mechanism of injury improve trauma diversion? A retrospective cross-sectional study","authors":"Wai Hung Yeung, Kit Shing Wong John, K. Tsui, Shing Kit Lam Tommy, C. Lui, C. Lau","doi":"10.1177/10249079221087800","DOIUrl":"https://doi.org/10.1177/10249079221087800","url":null,"abstract":"Objective: The objective of this study was to determine the impact of adding selected mechanism of injury (MOI) to the existing trauma diversion criteria adopted in Hong Kong. Method: This is a cross-sectional study based on the trauma registry of New Territory West Cluster (NTWC) of Hospital Authority from January 2017 to December 2019. All adult patients aged 18 years or above were recruited if their injury occurred in the catchment area of Pok Oi Hospital (POH) or Tin Shui Wai Hospital (TSWH). Performance of the protocol before and after MOI criteria being added in terms of over-diversion and under-diversion rate was determined. Model discrimination was evaluated by plotting the receiver operating characteristic curve, and the area under the curve was compared before and after MOI criteria added. Net reclassification improvement and integrated discrimination improvement indices were evaluated. Result: A total of 502 patients were included for analysis. Before MOI criteria were added, the over-diversion rate and under-diversion rate were 31.1% and 54.7%, respectively. After MOI criteria were added, the over-diversion rate and under-diversion rate were 33.1% and 34.3%, respectively. The receiver operating characteristic curve of current primary trauma diversion (PTD) criteria had an area under the curve of 66.9% (95% confidence interval: 63%–71%). After adding MOI criteria, the new receiver operating characteristic curve yielded an area under the curve of 73.7% (95% confidence interval: 70%–78%), which is significantly better (p < 0.001). Net reclassification improvement and integrated discrimination improvement indices indicated that including MOI criteria would improve the model prediction. Conclusion: Adding mechanism of injury can improve trauma diversion protocol performance.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47629933","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 : 2022-03-01DOI: 10.1177/10249079221081561
Andrew My Lim, S. Balsari, K. Hung
{"title":"COP 26, climate change, and emergency medicine: What must we do?","authors":"Andrew My Lim, S. Balsari, K. Hung","doi":"10.1177/10249079221081561","DOIUrl":"https://doi.org/10.1177/10249079221081561","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48757565","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 : 2022-02-25DOI: 10.1177/10249079221077497
A. Yim, Man-ho Ng, Sirius Shing-lam Kwok, Doretta Lo
Introduction: Procedural sedation and analgesia in children refer to the use of pharmacological measures to facilitate the management of painful procedures or emergency imaging, usually in emergency setting by non-anaesthetists. Emergency clinicians, nurses, patients and caregivers all have their roles to play in providing a safe sedation practice in the busy emergency department. Method: We did a retrospective review of all procedural sedation and analgesia done in patients below the age of 12 in our urgent care centre from October 2018 to August 2019. Results: There were 144 patients being identified in our review. Majority of them received intramuscular ketamine ranging from 2 to 4 mg/kg. There was no documented severe adverse effect in our review. Conclusion: Paediatric procedural sedation and analgesia is generally safe, efficient, adequate and facilitate early patient discharge.
{"title":"Retrospective review for procedural sedation and analgesia in paediatric patients in urgent care centre in a local private hospital in Hong Kong","authors":"A. Yim, Man-ho Ng, Sirius Shing-lam Kwok, Doretta Lo","doi":"10.1177/10249079221077497","DOIUrl":"https://doi.org/10.1177/10249079221077497","url":null,"abstract":"Introduction: Procedural sedation and analgesia in children refer to the use of pharmacological measures to facilitate the management of painful procedures or emergency imaging, usually in emergency setting by non-anaesthetists. Emergency clinicians, nurses, patients and caregivers all have their roles to play in providing a safe sedation practice in the busy emergency department. Method: We did a retrospective review of all procedural sedation and analgesia done in patients below the age of 12 in our urgent care centre from October 2018 to August 2019. Results: There were 144 patients being identified in our review. Majority of them received intramuscular ketamine ranging from 2 to 4 mg/kg. There was no documented severe adverse effect in our review. Conclusion: Paediatric procedural sedation and analgesia is generally safe, efficient, adequate and facilitate early patient discharge.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43631814","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 : 2022-02-17DOI: 10.1177/10249079221093950
J. Balderston, Christopher K Brown, VR Feeser, Z. Gertz
Background: Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique. Methods: This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0 to 14 years of age seen in the 12-month period from August 2018 to July 2019 were included. Descriptive statistical analyses were performed. Results: Data from 346 days and 64,966 patient encounters were analysed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/ day). The most common diagnoses were upper respiratory infections (URIs), gastroenteritis, asthma and dermatologic problems. The highest acuity diagnoses were neurologic prob-lems (59%), asthma (57%) and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED. Conclusion: This epidemiologic profile of illness seen in the HCM PED for improved resource utilization. opportunities for evidence-based care algo-rithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis. Study objective: Reducing excessive opioid prescribing in emergency departments (EDs) may prevent opioid addic-tion. We evaluated the largest personalized feedback and peer comparison intervention to date on emergency clinician opioid prescription rates in a national emergency clinician group. Methods: This interrupted time-series analysis of a quality improvement intervention included data from adults discharged from 102 EDs in 17 states from 1 January 2019 to 31 July 2021. From 16 June 2020 to 30 November 2020, site-level ED directors received emails on local opioid prescription rates. From 1 December 2020 to 31 July 2021, all clinicians were granted electronic dashboard access, which showed prescription rates compared with peers, and national ED leaders sent emails to high-pre-scribing clinicians and engaged in one-on-one conversa-tions. The primary outcome was opioid prescriptions per 100 discharges. Results: The study included 5,328,288 ED discharges from 924 physicians and 472 advanced practice provi
背景:非洲国家要继续降低儿童死亡率，就需要改善对患有急性疾病或受伤儿童的急诊护理。质量改进工作将取决于可靠的基线数据，但是关于莫桑比克儿科疾病的广度和严重程度的报告很少。方法:这是一项对马普托中心医院(HCM)儿科急诊科(PED)常规收集的提供者轮班汇总数据的回顾性研究，该医院是该国主要的学术和转诊医院。从2018年8月至2019年7月的12个月期间，所有0至14岁的儿童都包括在内。进行描述性统计分析。结果:分析了346天64,966例患者就诊的数据。绝大多数患者(96.4%)直接到PED就诊，没有从较低级别机构转诊。平均每天有188名患者就诊，3月份季节性变化最大(292名患者/天)。最常见的诊断是上呼吸道感染、肠胃炎、哮喘和皮肤病。最高的视力诊断是神经系统问题(59%)，哮喘(57%)和新生儿诊断(50%)。入院比例最大的诊断包括神经系统问题、疟疾和新生儿诊断。快速疟疾抗原检测是所有诊断类别中最常订购的实验室检测;全血细胞计数(FBC)和化学检查也很常见。在PED中很少进行尿液分析和HIV检测。结论:这种疾病的流行病学特征在HCM PED中看到，以改善资源利用。为常见诊断(如呼吸系统疾病)提供循证护理算法的机会，以改善患者护理和流程。PED还可以优化患者的实验室和放射学评估，并根据诊断制定标准化的入院标准。研究目的:减少急诊科(EDs)过量的阿片类药物处方可能预防阿片类药物成瘾。我们评估了迄今为止最大的个性化反馈和同行比较干预在国家紧急临床医生组的阿片类药物处方率。方法:这项质量改善干预措施的中断时间序列分析包括了2019年1月1日至2021年7月31日从17个州102个急诊科出院的成年人的数据。从2020年6月16日至2020年11月30日，站点级ED主任收到了有关当地阿片类药物处方率的电子邮件。从2020年12月1日至2021年7月31日，所有临床医生都获得了电子仪表板访问权限，该仪表板显示了与同行相比的处方率，国家急诊科领导向处方率高的临床医生发送电子邮件，并进行了一对一的对话。主要结果是每100例出院患者的阿片类药物处方。结果:该研究包括来自924名医生和472名高级执业医师的5,328,288名急诊科出院患者。阿片类药物处方率在现场级主任反馈期间无显著变化(平均差异= -0.3,95%置信区间(CI) = -0.6至-0.1)。在临床医生直接反馈期间，阿片类药物处方率从每100例出院10.4例下降到每100例出院8.4例(平均差异= -2.0,95% CI = -2.4至-1.5)。研究目的:产后从产科过渡到初级保健的挑战可能会增加急诊室(ED)就诊。本研究描述了产妇产后急诊科就诊的频率、特征和预测因素。我们使用负回归模型评估与相关社会人口统计学相关的任何ED就诊结果，并使用比率比(rr)和95%置信区间(95% ci)报告临床结果。从研究中得出的44.7%是一次或多次访问;在急诊科或院外急救期间接受无创通气治疗的患者队列中，29.7%的住院死亡率和再入院率:VentilaMadrid研究在多变量分析中，患者在日常生活活动方面存在先验依赖性(优势比(OR) = 2.4, 95%可信区间(CI) = 1.11至5.27)，简化急性生理评分II (SAPS II)的低-中度评分与高-非常高评分相比(OR = 2.69, 95% CI = 1.26至5.77)。oems通气后的死亡率与转移期间停止使用NIV相关(OR = 8.57, 95% CI = 2.19至33.60)。30天内再入院与组内(院内)急诊应用NIV相关;OR = 3.24, 95% CI = 2.62 ~ 6.45)和先验依赖性(OR = 2.08, 95% CI = 1.02 ~ 4.22)。结论:在医院急诊科和OHEMS治疗的患者具有相似的基线特征，尽管OHEMS组的急性发作更严重。未发现与住院死亡率相关的显著差异。 较高的死亡率与依赖、SAPS II评分大于52和停止使用NIV有关。再入院与医院急诊科的依赖和NIV治疗有关。
{"title":"Reciprocal Abstracts","authors":"J. Balderston, Christopher K Brown, VR Feeser, Z. Gertz","doi":"10.1177/10249079221093950","DOIUrl":"https://doi.org/10.1177/10249079221093950","url":null,"abstract":"Background: Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique. Methods: This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0 to 14 years of age seen in the 12-month period from August 2018 to July 2019 were included. Descriptive statistical analyses were performed. Results: Data from 346 days and 64,966 patient encounters were analysed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/ day). The most common diagnoses were upper respiratory infections (URIs), gastroenteritis, asthma and dermatologic problems. The highest acuity diagnoses were neurologic prob-lems (59%), asthma (57%) and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED. Conclusion: This epidemiologic profile of illness seen in the HCM PED for improved resource utilization. opportunities for evidence-based care algo-rithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis. Study objective: Reducing excessive opioid prescribing in emergency departments (EDs) may prevent opioid addic-tion. We evaluated the largest personalized feedback and peer comparison intervention to date on emergency clinician opioid prescription rates in a national emergency clinician group. Methods: This interrupted time-series analysis of a quality improvement intervention included data from adults discharged from 102 EDs in 17 states from 1 January 2019 to 31 July 2021. From 16 June 2020 to 30 November 2020, site-level ED directors received emails on local opioid prescription rates. From 1 December 2020 to 31 July 2021, all clinicians were granted electronic dashboard access, which showed prescription rates compared with peers, and national ED leaders sent emails to high-pre-scribing clinicians and engaged in one-on-one conversa-tions. The primary outcome was opioid prescriptions per 100 discharges. Results: The study included 5,328,288 ED discharges from 924 physicians and 472 advanced practice provi","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48249907","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 : 2022-01-24DOI: 10.1177/10249079211072403
C. Kong, W. K. To
Background: The incidence of maternal cardiac arrest is rising in recent years. Medical staff generally lack the experience of performing resuscitation on pregnant patients. Maternal cardiac arrest and perimortem caesarean section simulation training was newly introduced in the Advanced Life Support in Obstetrics provider courses in Hong Kong since April 2021. Objective: To evaluate the course participants’ opinions on maternal cardiac arrest simulation training. Methods: A questionnaire survey was conducted for all participants in the Advanced Life Support in Obstetrics provider course in April 2021 to assess their opinions on the usefulness of this training. Results: There were four Advanced Life Support in Obstetrics provider courses in April 2021 with 36 participants in each course, and 137 questionnaires were received at the end of the course. The response rate was 137/144 (95.1%). After excluding the questionnaires with incomplete information, 134 questionnaires were included for final analysis. Almost all of the participants agreed that the maternal cardiac arrest simulation training could help them in their work (97.8%), could improve their knowledge and skill (98.5%) and could improve team training and co-ordination (97.0%). The majority of them (97.0%) felt more confident in managing maternal cardiac arrest after the training, and 97.8% of participants felt that the perimortem caesarean section model was useful for training. Around 80% of the participants would recommend this course to their colleagues. There were no significant differences in opinions on the usefulness of this training among participants with regard to their specialty, whether they were doctors or nurses, their years of experience and the specific hospital settings. Conclusions: Maternal cardiac arrest simulation training was highly valued by all levels of obstetric, emergency medicine and anaesthesia staff in both public and private hospitals.
{"title":"Impact of foeto-maternal resuscitation and perimortem caesarean section simulation training: An opinion survey of healthcare participants","authors":"C. Kong, W. K. To","doi":"10.1177/10249079211072403","DOIUrl":"https://doi.org/10.1177/10249079211072403","url":null,"abstract":"Background: The incidence of maternal cardiac arrest is rising in recent years. Medical staff generally lack the experience of performing resuscitation on pregnant patients. Maternal cardiac arrest and perimortem caesarean section simulation training was newly introduced in the Advanced Life Support in Obstetrics provider courses in Hong Kong since April 2021. Objective: To evaluate the course participants’ opinions on maternal cardiac arrest simulation training. Methods: A questionnaire survey was conducted for all participants in the Advanced Life Support in Obstetrics provider course in April 2021 to assess their opinions on the usefulness of this training. Results: There were four Advanced Life Support in Obstetrics provider courses in April 2021 with 36 participants in each course, and 137 questionnaires were received at the end of the course. The response rate was 137/144 (95.1%). After excluding the questionnaires with incomplete information, 134 questionnaires were included for final analysis. Almost all of the participants agreed that the maternal cardiac arrest simulation training could help them in their work (97.8%), could improve their knowledge and skill (98.5%) and could improve team training and co-ordination (97.0%). The majority of them (97.0%) felt more confident in managing maternal cardiac arrest after the training, and 97.8% of participants felt that the perimortem caesarean section model was useful for training. Around 80% of the participants would recommend this course to their colleagues. There were no significant differences in opinions on the usefulness of this training among participants with regard to their specialty, whether they were doctors or nurses, their years of experience and the specific hospital settings. Conclusions: Maternal cardiac arrest simulation training was highly valued by all levels of obstetric, emergency medicine and anaesthesia staff in both public and private hospitals.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43003915","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 : 2022-01-01DOI: 10.1177/10249079211063270
K. Hung, Emily Y. Y. Chan, C. Graham
{"title":"Disaster preparedness of emergency departments in Hong Kong","authors":"K. Hung, Emily Y. Y. Chan, C. Graham","doi":"10.1177/10249079211063270","DOIUrl":"https://doi.org/10.1177/10249079211063270","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47883052","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 : 2021-11-08DOI: 10.1177/10249079211049939
Ka Wing Tam, C. Chan, Sha Liu
Introduction: Development of coagulopathy after anticoagulant rodenticide ingestion varies among patients. This study aimed to identify factors that were associated with coagulopathy after anticoagulant rodenticide ingestion. Methods: This was a retrospective cohort study, conducted in the Hong Kong Poison Information Centre. All patients who reported rodenticide exposure and presented to the Accident and Emergency Department from 1 January 2010 to 31 December 2019 were recruited. Coagulopathy was defined as International Normalized Ratio of 1.3 or above. Results: One hundred sixty-nine patients were included in the final analysis. The median age was 44 years old. Forty-nine patients developed coagulopathy (International Normalized Ratio ⩾1.3). Univariate analysis (at p < 0.05) showed that age (p = 0.003), ingestion of first-generation anticoagulant rodenticide (p = 0.017), ingestion of more than one pack (p < 0.001), intentional ingestion (p = 0.002), hypoalbuminemia (p < 0.001), elevated alanine aminotransferase level (p = 0.041) and abnormal estimated glomerular filtration rate (p = 0.005) on presentation, and co-ingestion with paracetamol (p = 0.018) were associated with coagulopathy after anticoagulant rodenticide ingestion. Among these, ingestion of more than one pack (p < 0.001; odds ratio = 19.8; 95% confidence interval = 6.78–65.7), ingestion of first-generation anticoagulant rodenticide (p = 0.006; odds ratio = 5.2; 95% confidence interval = 1.96–15.2), hypoalbuminemia (p < 0.001; odds ratio = 22.4; 95% confidence interval = 6.17–99.0) and elevated alanine aminotransferase level on presentation (p = 0.039; odds ratio = 7.11; 95% confidence interval = 1.58–33.1) were statistically significant in the multivariate analysis. Conclusion: Ingestion of more than one pack and ingestion of first-generation anticoagulant rodenticides were significantly associated with the development of coagulopathy after anticoagulant rodenticide ingestion. Patients who developed hypoalbuminemia or elevated alanine aminotransferase level as a result of anticoagulant rodenticide ingestion were also significantly associated with the development of coagulopathy.
{"title":"Anticoagulant rodenticide ingestion: Who will develop coagulopathy?","authors":"Ka Wing Tam, C. Chan, Sha Liu","doi":"10.1177/10249079211049939","DOIUrl":"https://doi.org/10.1177/10249079211049939","url":null,"abstract":"Introduction: Development of coagulopathy after anticoagulant rodenticide ingestion varies among patients. This study aimed to identify factors that were associated with coagulopathy after anticoagulant rodenticide ingestion. Methods: This was a retrospective cohort study, conducted in the Hong Kong Poison Information Centre. All patients who reported rodenticide exposure and presented to the Accident and Emergency Department from 1 January 2010 to 31 December 2019 were recruited. Coagulopathy was defined as International Normalized Ratio of 1.3 or above. Results: One hundred sixty-nine patients were included in the final analysis. The median age was 44 years old. Forty-nine patients developed coagulopathy (International Normalized Ratio ⩾1.3). Univariate analysis (at p < 0.05) showed that age (p = 0.003), ingestion of first-generation anticoagulant rodenticide (p = 0.017), ingestion of more than one pack (p < 0.001), intentional ingestion (p = 0.002), hypoalbuminemia (p < 0.001), elevated alanine aminotransferase level (p = 0.041) and abnormal estimated glomerular filtration rate (p = 0.005) on presentation, and co-ingestion with paracetamol (p = 0.018) were associated with coagulopathy after anticoagulant rodenticide ingestion. Among these, ingestion of more than one pack (p < 0.001; odds ratio = 19.8; 95% confidence interval = 6.78–65.7), ingestion of first-generation anticoagulant rodenticide (p = 0.006; odds ratio = 5.2; 95% confidence interval = 1.96–15.2), hypoalbuminemia (p < 0.001; odds ratio = 22.4; 95% confidence interval = 6.17–99.0) and elevated alanine aminotransferase level on presentation (p = 0.039; odds ratio = 7.11; 95% confidence interval = 1.58–33.1) were statistically significant in the multivariate analysis. Conclusion: Ingestion of more than one pack and ingestion of first-generation anticoagulant rodenticides were significantly associated with the development of coagulopathy after anticoagulant rodenticide ingestion. Patients who developed hypoalbuminemia or elevated alanine aminotransferase level as a result of anticoagulant rodenticide ingestion were also significantly associated with the development of coagulopathy.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2021-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41892965","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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