Pub Date : 2021-02-15DOI: 10.1177/1024907921989499
M. I. Zakaria, Ruzaina Remeli, Mohd Fitri Ahmad Shahamir, Mohd Hafyzuddin Md Yusuf, Mohammad Aizuddin Azizah Ariffin, A. M. Noor Azhar
Introduction: Burnout is a syndrome occurring from an overwhelming workplace stress. The study was done at a large teaching hospital identified as a COVID-19 treating hospital. During COVID-19 pandemic, the country was in Movement Control Order since 18 March 2020 to contain the spread of the virus, and thus, it has increased the job workload and responsibility. The purpose of this study was to identify the prevalence of burnout among emergency healthcare worker in this hospital and to identify the factors contributed to the burnout. Methods: A cross-sectional study was conducted using a questionnaire among emergency healthcare worker from 8 May 2020 to 15 May 2020 during the Conditional Movement Control Order. The questionnaire was adapted from Michelle Post, Public Welfare, Vol. 39, No. 1, 1981, American Public Welfare Association and distributed via Google Forms. It consisted of 28 questions and was rated based on a five-point Likert-type scale. The questions were then summed up to determine the burnout levels. Results: There were 216 respondents with 65.7% were nurses, 17.1% were doctors, and the rest were assistant medical officer. 51.3% of the respondents had burnout with 61.2% of nurses, 35.1% of doctors, and 29.6% of assistant medical officer. There was weak correlation (r = 0.148) with the years of experience working in emergency department and the level of burnout (p = 0.03). Among the burnout features were fatigue with 52.2% and frequent physical illness and feel unappreciated with 48.6% and 45.9%, respectively. The job-related issues which predisposed to burnout were demand coping with an angry public with 70.2%, job overload 63.9%, lack clear guideline or rapid program changes 54%, and pay too little 53.1%. Conclusion: Emergency healthcare worker has a high rate of burnout especially among the nurses. The factors leading to burnout were frequent exposure to angry public, job overload, lack of clear guidelines, and perception of underpaid.
{"title":"Assessment of burnout among emergency medicine healthcare workers in a teaching hospital in Malaysia during COVID-19 pandemic","authors":"M. I. Zakaria, Ruzaina Remeli, Mohd Fitri Ahmad Shahamir, Mohd Hafyzuddin Md Yusuf, Mohammad Aizuddin Azizah Ariffin, A. M. Noor Azhar","doi":"10.1177/1024907921989499","DOIUrl":"https://doi.org/10.1177/1024907921989499","url":null,"abstract":"Introduction: Burnout is a syndrome occurring from an overwhelming workplace stress. The study was done at a large teaching hospital identified as a COVID-19 treating hospital. During COVID-19 pandemic, the country was in Movement Control Order since 18 March 2020 to contain the spread of the virus, and thus, it has increased the job workload and responsibility. The purpose of this study was to identify the prevalence of burnout among emergency healthcare worker in this hospital and to identify the factors contributed to the burnout. Methods: A cross-sectional study was conducted using a questionnaire among emergency healthcare worker from 8 May 2020 to 15 May 2020 during the Conditional Movement Control Order. The questionnaire was adapted from Michelle Post, Public Welfare, Vol. 39, No. 1, 1981, American Public Welfare Association and distributed via Google Forms. It consisted of 28 questions and was rated based on a five-point Likert-type scale. The questions were then summed up to determine the burnout levels. Results: There were 216 respondents with 65.7% were nurses, 17.1% were doctors, and the rest were assistant medical officer. 51.3% of the respondents had burnout with 61.2% of nurses, 35.1% of doctors, and 29.6% of assistant medical officer. There was weak correlation (r = 0.148) with the years of experience working in emergency department and the level of burnout (p = 0.03). Among the burnout features were fatigue with 52.2% and frequent physical illness and feel unappreciated with 48.6% and 45.9%, respectively. The job-related issues which predisposed to burnout were demand coping with an angry public with 70.2%, job overload 63.9%, lack clear guideline or rapid program changes 54%, and pay too little 53.1%. Conclusion: Emergency healthcare worker has a high rate of burnout especially among the nurses. The factors leading to burnout were frequent exposure to angry public, job overload, lack of clear guidelines, and perception of underpaid.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"254 - 259"},"PeriodicalIF":0.6,"publicationDate":"2021-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907921989499","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46246562","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 : 2021-01-01DOI: 10.1177/10249079211035850
Z. Abid, N. Kuppermann, Daniel, J. Tancredi, S. Mark, Zocchi
This study aimed to determine the frequency and factors related to punitive patient safety event report submissions, referred to as Patient Safety Net reports, or PSNs B Objective: b To analyze emergency department (ED) revisits from patients discharged with possible coronavirus disease 2019 (COVID-19) B Editor's note: b The Hong Kong Journal of Emergency Medicine 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 [Extracted from the article] Copyright of Hong Kong Journal of Emergency Medicine is the property of Sage Publications Inc and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )
{"title":"Reciprocal Abstracts","authors":"Z. Abid, N. Kuppermann, Daniel, J. Tancredi, S. Mark, Zocchi","doi":"10.1177/10249079211035850","DOIUrl":"https://doi.org/10.1177/10249079211035850","url":null,"abstract":"This study aimed to determine the frequency and factors related to punitive patient safety event report submissions, referred to as Patient Safety Net reports, or PSNs B Objective: b To analyze emergency department (ED) revisits from patients discharged with possible coronavirus disease 2019 (COVID-19) B Editor's note: b The Hong Kong Journal of Emergency Medicine 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 [Extracted from the article] Copyright of Hong Kong Journal of Emergency Medicine is the property of Sage Publications Inc and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"366 3","pages":"328 - 331"},"PeriodicalIF":0.6,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41290894","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 : 2020-12-29DOI: 10.1177/1024907920982758
S. Yu, J. S. K. Lau, Puisy Yau Ng Chan, Pui Gay Kan
A middle-aged man presented to the emergency department after a seemingly trivial head injury. Recognition of pathognomonic radiological findings allowed early diagnosis of a potentially life-threatening condition. The patient recovered uneventfully after prompt neurosurgical intervention.
{"title":"Beware of the 3776.24 m peak","authors":"S. Yu, J. S. K. Lau, Puisy Yau Ng Chan, Pui Gay Kan","doi":"10.1177/1024907920982758","DOIUrl":"https://doi.org/10.1177/1024907920982758","url":null,"abstract":"A middle-aged man presented to the emergency department after a seemingly trivial head injury. Recognition of pathognomonic radiological findings allowed early diagnosis of a potentially life-threatening condition. The patient recovered uneventfully after prompt neurosurgical intervention.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"193 - 195"},"PeriodicalIF":0.6,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920982758","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46671443","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 : 2020-12-21DOI: 10.1177/1024907920981260
Syed Abdul Kader Mohamed Saleem, I. Mohd Saiboon, M. Amir
Tension pneumothorax is one of the commonest life-threatening condition seen in multiple injury or polytrauma trauma victims. Chest tube insertion has been the mainstay treatment for tension pneumothorax since early 1970s until today. Despite being a common procedure performed by an emergency resident, the incidence of complications related to the procedure remains significantly high. Iatrogenic complications are particularly more common in patients that are critically ill, obese or with a flail chest. This report will be discussing on an ectopic chest tube insertion during management of a case of traumatic tension pneumothorax in an obese patient with flail chest. Further discussions are on various recent updates on chest tube insertion procedures in an emergency setting. It is vital to understand that prior to chest tube insertion, it is important to acknowledge a possibility of complicated procedure by stratifying the risk of individual patients. Hence, this may reduce the risk of iatrogenic complications.
{"title":"Where is the chest tube? Ectopic chest tube","authors":"Syed Abdul Kader Mohamed Saleem, I. Mohd Saiboon, M. Amir","doi":"10.1177/1024907920981260","DOIUrl":"https://doi.org/10.1177/1024907920981260","url":null,"abstract":"Tension pneumothorax is one of the commonest life-threatening condition seen in multiple injury or polytrauma trauma victims. Chest tube insertion has been the mainstay treatment for tension pneumothorax since early 1970s until today. Despite being a common procedure performed by an emergency resident, the incidence of complications related to the procedure remains significantly high. Iatrogenic complications are particularly more common in patients that are critically ill, obese or with a flail chest. This report will be discussing on an ectopic chest tube insertion during management of a case of traumatic tension pneumothorax in an obese patient with flail chest. Further discussions are on various recent updates on chest tube insertion procedures in an emergency setting. It is vital to understand that prior to chest tube insertion, it is important to acknowledge a possibility of complicated procedure by stratifying the risk of individual patients. Hence, this may reduce the risk of iatrogenic complications.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"21S - 25S"},"PeriodicalIF":0.6,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920981260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42438995","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 : 2020-12-10DOI: 10.1177/1024907920975368
Sultan Tuna Akgol Gur, S. Doğruyol, A. Koçak, Tuğba Sanalp Menekşe, I. Akbas, Meryem Betos Koçak, Z. Çakır
Background: Acute musculoskeletal pain is one of the common causes of emergency admissions. Topical analgesics are an easily tolerated option in the treatment of these pains. Objective: This study aimed to compare the efficacy of topical capsaicin and topical non-steroidal anti-inflammatory drugs in acute musculoskeletal injuries. Methods: In this prospective, randomized, controlled, double-blinded study, patients were allocated to two groups—the topical non-steroidal anti-inflammatory drug (n = 60) and topical capsaicin (n = 59). For both groups, the first dose treatment was applied as a thin layer in the emergency department to a maximum area of 5 × 5 cm. The remaining doses were administered at home by the patients for 72 h. The initial visual analog scale scores were compared with the 60th and 120th minute as well as the 24th and 72nd hour values. Differences between the visual analog scale scores, clinical response to the treatment, and side effects were evaluated. Results: The proportional reduction in visual analog scale scores for topical capsaicin was significantly higher, especially at 36 and 72 h. These rates were 0.75 (95% confidence interval: 0.77–1.42; p = 0.029) and 9.08 (95% confidence interval: 1.02–17.14; p = 0.028) at 36 h, respectively. At 72 h, they were 1.27 (95% confidence interval: 0.48–2.05; p = 0.002) and 17.07 (95% confidence interval: 8.39–25.76; p < 0.001), respectively. In the topical capsaicin group, the clinical response to treatment was significantly higher (p = 0.001). Treatment-related systemic side effects were experienced only in the topical non-steroidal anti-inflammatory drug group (1.7%). Conclusion: Topical capsaicin can be used safely in patients presenting to the emergency department with acute pain with its high analgesic efficacy and absence of systemic side effects.
{"title":"Topical capsaicin versus topical ibuprofen in acute musculoskeletal injuries: A randomized, double-blind trial","authors":"Sultan Tuna Akgol Gur, S. Doğruyol, A. Koçak, Tuğba Sanalp Menekşe, I. Akbas, Meryem Betos Koçak, Z. Çakır","doi":"10.1177/1024907920975368","DOIUrl":"https://doi.org/10.1177/1024907920975368","url":null,"abstract":"Background: Acute musculoskeletal pain is one of the common causes of emergency admissions. Topical analgesics are an easily tolerated option in the treatment of these pains. Objective: This study aimed to compare the efficacy of topical capsaicin and topical non-steroidal anti-inflammatory drugs in acute musculoskeletal injuries. Methods: In this prospective, randomized, controlled, double-blinded study, patients were allocated to two groups—the topical non-steroidal anti-inflammatory drug (n = 60) and topical capsaicin (n = 59). For both groups, the first dose treatment was applied as a thin layer in the emergency department to a maximum area of 5 × 5 cm. The remaining doses were administered at home by the patients for 72 h. The initial visual analog scale scores were compared with the 60th and 120th minute as well as the 24th and 72nd hour values. Differences between the visual analog scale scores, clinical response to the treatment, and side effects were evaluated. Results: The proportional reduction in visual analog scale scores for topical capsaicin was significantly higher, especially at 36 and 72 h. These rates were 0.75 (95% confidence interval: 0.77–1.42; p = 0.029) and 9.08 (95% confidence interval: 1.02–17.14; p = 0.028) at 36 h, respectively. At 72 h, they were 1.27 (95% confidence interval: 0.48–2.05; p = 0.002) and 17.07 (95% confidence interval: 8.39–25.76; p < 0.001), respectively. In the topical capsaicin group, the clinical response to treatment was significantly higher (p = 0.001). Treatment-related systemic side effects were experienced only in the topical non-steroidal anti-inflammatory drug group (1.7%). Conclusion: Topical capsaicin can be used safely in patients presenting to the emergency department with acute pain with its high analgesic efficacy and absence of systemic side effects.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"210 - 216"},"PeriodicalIF":0.6,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920975368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42665700","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 : 2020-11-30DOI: 10.1177/1024907920976076
H. Hsu, Wei-Jing Lee
A 37-year-old HIV-positive woman presented to the emergency department with fever, headache, confusion, and seizures for 3 days. Computed tomography of the head with contrast demonstrated multiple ...
{"title":"A woman with fever and confusion","authors":"H. Hsu, Wei-Jing Lee","doi":"10.1177/1024907920976076","DOIUrl":"https://doi.org/10.1177/1024907920976076","url":null,"abstract":"A 37-year-old HIV-positive woman presented to the emergency department with fever, headache, confusion, and seizures for 3 days. Computed tomography of the head with contrast demonstrated multiple ...","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"1 1","pages":"102490792097607"},"PeriodicalIF":0.6,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920976076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48569300","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 : 2020-11-27DOI: 10.1177/1024907920974198
İsmail Erdemi̇r, A. Sarıhan, S. Kalemci, Ç. Can, Fatih Rahman
Butterfly vertebra and block vertebra are usually reported incidental radiological view, which is a rare congenital defect of spine. Butterfly vertebra is a body formation characterized by anterior and median aplasia. The block vertebra is the result of an embryonically incomplete separation of vertebral bodies or arches or both. This rare congenital anomalies butterfly and block vertebra are usually stable and do not cause clinical symptoms.
{"title":"Butterfly vertebra and block vertebra cause overdiagnosis in trauma patients","authors":"İsmail Erdemi̇r, A. Sarıhan, S. Kalemci, Ç. Can, Fatih Rahman","doi":"10.1177/1024907920974198","DOIUrl":"https://doi.org/10.1177/1024907920974198","url":null,"abstract":"Butterfly vertebra and block vertebra are usually reported incidental radiological view, which is a rare congenital defect of spine. Butterfly vertebra is a body formation characterized by anterior and median aplasia. The block vertebra is the result of an embryonically incomplete separation of vertebral bodies or arches or both. This rare congenital anomalies butterfly and block vertebra are usually stable and do not cause clinical symptoms.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"18S - 20S"},"PeriodicalIF":0.6,"publicationDate":"2020-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920974198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716335","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 : 2020-11-26DOI: 10.1177/1024907920973556
D. Tan, Jing Jing Chan
Introduction: Flood syndrome is a rare and potentially fatal complication of liver cirrhosis with gross ascites. Case presentation: We present a case of Flood syndrome in a gentleman with alcoholic cirrhosis and ascites who had sudden spontaneous rupture of umbilical hernia, resulting in sudden gush of ascitic fluid from the hernia. The wound was cleaned and covered in sterile dressing and was admitted for further management. His umbilical hernia wound was closed at bedside by General Surgery team and he underwent ultrasound-guided ascitic drain insertion by Interventional Radiology. His stay was complicated by bacterial peritonitis which was treated with intravenous antibiotic. Patient eventually recovered and was discharged well. Discussion: Flood syndrome has high complication and mortality rate. Recent reported cases were reviewed, focusing on the causes of cirrhosis, complications of Flood syndrome, treatments provided and the outcomes. Conclusion: There is currently no standard guideline for the management of Flood syndrome which falls in the grey area between medical and surgical management. Proper medical management with early surgical consultation is important to reduce the morbidity and mortality for these patients.
{"title":"A rare case of Flood syndrome in emergency department: A case report and review of recent reported cases","authors":"D. Tan, Jing Jing Chan","doi":"10.1177/1024907920973556","DOIUrl":"https://doi.org/10.1177/1024907920973556","url":null,"abstract":"Introduction: Flood syndrome is a rare and potentially fatal complication of liver cirrhosis with gross ascites. Case presentation: We present a case of Flood syndrome in a gentleman with alcoholic cirrhosis and ascites who had sudden spontaneous rupture of umbilical hernia, resulting in sudden gush of ascitic fluid from the hernia. The wound was cleaned and covered in sterile dressing and was admitted for further management. His umbilical hernia wound was closed at bedside by General Surgery team and he underwent ultrasound-guided ascitic drain insertion by Interventional Radiology. His stay was complicated by bacterial peritonitis which was treated with intravenous antibiotic. Patient eventually recovered and was discharged well. Discussion: Flood syndrome has high complication and mortality rate. Recent reported cases were reviewed, focusing on the causes of cirrhosis, complications of Flood syndrome, treatments provided and the outcomes. Conclusion: There is currently no standard guideline for the management of Flood syndrome which falls in the grey area between medical and surgical management. Proper medical management with early surgical consultation is important to reduce the morbidity and mortality for these patients.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"14S - 17S"},"PeriodicalIF":0.6,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920973556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45202085","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 : 2020-11-26DOI: 10.1177/1024907920975371
Jon Soo Kim, Jin Cheol Kim, W. Sung
Background: Minor head trauma is frequently presented to the pediatric emergency department. Despite the burden this injury poses on public health, evidence-based clinical guidelines on the assessment and management of pediatric minor head trauma remain unestablished, particularly in children below 2 years. We aimed to assess the diagnostic accuracy of a clinical decision rule (Pediatric Emergency Care Applied Research Network rule) and physician discretion in the recognition of practically important traumatic brain injury in children below 2 years of age presenting with minor head trauma to the emergency department. Methods: The medical records of children younger than 2 years presenting with head trauma to the emergency department were reviewed with Glasgow Coma Scale scores of 14–15. Practically important traumatic brain injury is a clinically essential traumatic brain injury including all cranial abnormalities (e.g. skull fracture) detected by computed tomography. All predictor variables of the Pediatric Emergency Care Applied Research Network rule and practically important traumatic brain injury outcomes were validated. Results: We enrolled and analyzed 433 children below 2 years. The most frequently observed mechanisms of injury in decreasing order were as follows: falls > 90 cm, head struck by high-impact objects, slip down, and automobile traffic accident. Of 224 children, positive findings were observed in 35 and 144 had one or more predictors of Pediatric Emergency Care Applied Research Network rule. The sensitivity, specificity, and negative likelihood ratio of the Pediatric Emergency Care Applied Research Network rule for practically important traumatic brain injury were 94.3%, 41.3%, and 0.14, respectively. Conclusion: The Pediatric Emergency Care Applied Research Network rule would assist in clinical decision-making to appropriately detect potential head injuries in children below 2 years, thereby reducing unnecessary performance of computed tomography scan.
{"title":"Identification of practically important traumatic brain injury using Pediatric Emergency Care Applied Research Network rule in children younger than 2 years with minor head trauma","authors":"Jon Soo Kim, Jin Cheol Kim, W. Sung","doi":"10.1177/1024907920975371","DOIUrl":"https://doi.org/10.1177/1024907920975371","url":null,"abstract":"Background: Minor head trauma is frequently presented to the pediatric emergency department. Despite the burden this injury poses on public health, evidence-based clinical guidelines on the assessment and management of pediatric minor head trauma remain unestablished, particularly in children below 2 years. We aimed to assess the diagnostic accuracy of a clinical decision rule (Pediatric Emergency Care Applied Research Network rule) and physician discretion in the recognition of practically important traumatic brain injury in children below 2 years of age presenting with minor head trauma to the emergency department. Methods: The medical records of children younger than 2 years presenting with head trauma to the emergency department were reviewed with Glasgow Coma Scale scores of 14–15. Practically important traumatic brain injury is a clinically essential traumatic brain injury including all cranial abnormalities (e.g. skull fracture) detected by computed tomography. All predictor variables of the Pediatric Emergency Care Applied Research Network rule and practically important traumatic brain injury outcomes were validated. Results: We enrolled and analyzed 433 children below 2 years. The most frequently observed mechanisms of injury in decreasing order were as follows: falls > 90 cm, head struck by high-impact objects, slip down, and automobile traffic accident. Of 224 children, positive findings were observed in 35 and 144 had one or more predictors of Pediatric Emergency Care Applied Research Network rule. The sensitivity, specificity, and negative likelihood ratio of the Pediatric Emergency Care Applied Research Network rule for practically important traumatic brain injury were 94.3%, 41.3%, and 0.14, respectively. Conclusion: The Pediatric Emergency Care Applied Research Network rule would assist in clinical decision-making to appropriately detect potential head injuries in children below 2 years, thereby reducing unnecessary performance of computed tomography scan.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"217 - 224"},"PeriodicalIF":0.6,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920975371","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43806672","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 : 2020-11-25DOI: 10.1177/1024907920973561
M. Lau, Cheung Lun William Wong
Introduction: Shock index is defined as heart rate divided by systolic blood pressure. It is reported as a predictor of morbidity and mortality in trauma and acute myocardial infarction in previous studies. It may be valuable in evaluation of calcium channel blocker poisoning. The objective of this study is to examine the probability of serious outcome based on first measured shock index in patients who presented to emergency department with calcium channel blocker poisoning. Methods: A retrospective chart review was conducted on calcium channel blocker poisoning cases in Hong Kong Poison Information Centre from 1 July 2008 to 30 June 2017. Shock index was calculated with blood pressure and pulse measurement at emergency department triage. Odds ratios of various variables for major outcome, mortality, intensive care unit admission, length of stay in acute hospital were calculated by multivariate analysis or negative binomial regression where appropriate. The performance of shock index in predicting major outcome was evaluated with receiver operating characteristic curve. Results: A total of 390 cases were identified, of whom 25.1% developed major outcome and 5.6% died. Shock index showed significant association with major outcome (odds ratio: 17.017, 95% confidence interval: 5.521–52.455). The area under the receiver operating characteristic curve for shock index in predicting major outcome was 0.7008 (95% confidence interval: 0.64–0.76). Conclusion: Higher shock index is associated with worse patient outcome in calcium channel blocker poisoning. However, shock index alone is not reliable in predicting patient outcome. Further research is needed before shock index can be incorporated for use in patient management in poisoning with calcium channel blocker or other anti-hypertensives.
{"title":"Utility of triage shock index in predicting patient outcome in calcium channel blocker poisoning","authors":"M. Lau, Cheung Lun William Wong","doi":"10.1177/1024907920973561","DOIUrl":"https://doi.org/10.1177/1024907920973561","url":null,"abstract":"Introduction: Shock index is defined as heart rate divided by systolic blood pressure. It is reported as a predictor of morbidity and mortality in trauma and acute myocardial infarction in previous studies. It may be valuable in evaluation of calcium channel blocker poisoning. The objective of this study is to examine the probability of serious outcome based on first measured shock index in patients who presented to emergency department with calcium channel blocker poisoning. Methods: A retrospective chart review was conducted on calcium channel blocker poisoning cases in Hong Kong Poison Information Centre from 1 July 2008 to 30 June 2017. Shock index was calculated with blood pressure and pulse measurement at emergency department triage. Odds ratios of various variables for major outcome, mortality, intensive care unit admission, length of stay in acute hospital were calculated by multivariate analysis or negative binomial regression where appropriate. The performance of shock index in predicting major outcome was evaluated with receiver operating characteristic curve. Results: A total of 390 cases were identified, of whom 25.1% developed major outcome and 5.6% died. Shock index showed significant association with major outcome (odds ratio: 17.017, 95% confidence interval: 5.521–52.455). The area under the receiver operating characteristic curve for shock index in predicting major outcome was 0.7008 (95% confidence interval: 0.64–0.76). Conclusion: Higher shock index is associated with worse patient outcome in calcium channel blocker poisoning. However, shock index alone is not reliable in predicting patient outcome. Further research is needed before shock index can be incorporated for use in patient management in poisoning with calcium channel blocker or other anti-hypertensives.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"73 - 78"},"PeriodicalIF":0.6,"publicationDate":"2020-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907920973561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45320207","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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