Accident Department Research Articles

Association between ambient temperature and increased total length of hospital stay of patients with cardiopulmonary disease in Hong Kong

BackgroundWhile temperature extremes have been shown to be associated with an increased risk of hospital admissions, evidence of their impact on the length of hospital stay, which may capture the lingering effects of temperature extremes, is scarce.ObjectivesWe aimed to evaluate the association between daily variation in ambient temperature and daily variation in daily total length of stay (daily TLOS), a composite measure encompassing the daily count of hospital admissions and their corresponding length of hospital stay among cardiopulmonary patients. Additionally, we quantified the burden of TLOS attributable to non-optimal temperatures among Hong Kong’s older adult population.MethodsWe used a generalized linear regression with a distributed lag non-linear model to estimate the association between ambient temperature and daily TLOS. The analysis used 13 years of time-series data (1998–2010) on daily temperature and hospital admissions for cardiopulmonary diseases through accident and emergency departments among Hong Kong’s older adult population. We quantified the attributable risk of TLOS by calculating the temperature-related days of hospital stay and the attributable fraction (AF).ResultsWe recorded a total of 4,095,722 hospital stay days for cardiovascular patients and 4,492,697 days for respiratory patients. We found that both cold and heat were associated with increased TLOS for cardiopulmonary disease. The temperature-related AF was 11.5% (95% empirical CI: 5.3–17.2%) for cardiovascular disease, corresponding to an annual increase of 36,174 days (95% empirical CI: 15,286–57,018). For respiratory disease, the AF was 10.7% (95% empirical CI: 7.1–13.9%), equating to an annual increase of 36,897 days (95% empirical CI: 24,949–49,024) days annually.ConclusionExtreme temperatures were associated with increased TLOS for cardiopulmonary patients in Hong Kong’s older adult population. These findings highlight the need for hospitals to prepare in advance for extreme temperature events by implementing specific measures in terms of human resources and medical resources. In addition, the results provide valuable scientific evidence to support public health policies and inform hospital planning and management.

Ruptured: Retrospective Analysis Undertaken for Patients Treated for Unexplained Retroperitoneal or Abdominal Pain in the Emergency Department

Aims/Background Symptomatic abdominal aortic aneurysms carry significant mortality risk. This is supplemented by the Royal College of Emergency Medicine guidelines which suggest imaging for patients 50 years of age or older presenting with unexplained abdominal, flank, or back pain. This study aimed to evaluate the prevalence and mortality rates of patients with symptomatic abdominal aortic aneurysms in a high-risk population and to assess scanning rates in the accident and emergency department. Methods Retrospective analysis of patients presenting to the accident and emergency department at a district general hospital over 6 months was performed. Patients 50 years of age or older presenting with abdominal, flank, or back pain were included. Collected data points included; whether or not a scan was performed in the emergency department, the modality of imaging, whether an abdominal aortic aneurysm was identified on the scan, the age of patients with an abdominal aortic aneurysms identified on the scan, size of the identified abdominal aortic aneurysms, primary diagnosis at the time of review in the emergency department, and all-cause mortality rates. Results 361 patients were identified to have an indicated scan, of which only 122 (33.8%) had a scan in the emergency department. In the syndromic group, the prevalence and 30-day mortality of patients with an abdominal aortic aneurysm were 5.5% and 1.1% respectively. Only 12 out of 20 patients with an abdominal aortic aneurysm were identified in the emergency department. Conclusion The criteria outlined by the Royal College of Emergency Medicine does well at identifying patients with abdominal aortic aneurysms when followed. However, this study reveals that scanning rates in the emergency department are low. The encouragement of scanning and improved ultrasound skills among emergency medicine clinicians can reduce missed diagnoses. Additionally, we recommend further studies to assess the mortality rates of emergent abdominal aortic aneurysm presentations.

The effect of visual acuity measurement on triage effectiveness in an ophthalmic emergency department.

The effect of pre-triage visual acuity (VA) measurement on triage accuracy in a busy ophthalmic casualty department was investigated as a possible means to improve triage quality. All 576 patients attending the accident and emergency department (A&E) at the Birmingham and Midland Eye Centre (BMEC) over a period of 4days were included in this prospective cross-sectional study. Patients were assigned to two groups: those who underwent a VA measurement prior to triage (n = 242) and a control group who did not have a VA measurement (n = 234). Clinicians who were masked from the allocation also assessed whether they agreed with the triage decision after assessing each patient. Triage outcomes were recorded for 469 (81%) patients. Those with a pre-triage VA measurement were more likely to be assessed as more urgent (p = 0.005) and less likely to be discharged (p = 0.04). 248 (43%) patients had clinician response with corresponding triage records, of which 136 (55%) had prior VA measurement and 112 (45%) were in the control group. Clinicians responded that patients with VA measurement prior to triage were more accurately triaged than the control group (66% and 54%; p = 0.03). VA measurement prior to triage can help improve triage accuracy and allow better allocation of resources at an overcrowded eye-dedicated emergency department. However, waiting times may increase due to longer triage duration and more patients to be triaged into urgent pathway. Greater staffing resources may be necessary to complement the proposed change to avoid undermining triage efficiency.

Incidence of 30-day readmission after total knee arthroplasty and its associated factors in Hong Kong.

Total knee arthroplasty (TKA) is one of the most commonly performed orthopaedic procedures worldwide, due to the increased prevalence of osteoarthritis associated with an ageing global population. Although many studies have focused on the causes of readmission among TKA patients within 30 days post-surgery, none have been conducted in Hong Kong. This study investigated the 30-day readmission rate, causes, and risk factors among TKA patients in Hong Kong. This retrospective review included patients who underwent TKA at a local university-affiliated hospital between 2001 and 2020. Eligible patients were identified using the Clinical Data Analysis and Reporting System and electronic patient records. Their data were analysed to determine the 30-day readmission rate, risk factors, and underlying causes. Among the 3827 TKA patients included, the male-to-female ratio was 1:2.78 (1012:2815) and the mean age (±standard deviation) was 71.11±8.82 years. Of these patients, 3.4% underwent unplanned readmission to hospitals through the Accident and Emergency Department within 30 days of TKA. The most common causes of readmission were knee pain (33.1%), knee swelling (26.2%), and gastrointestinal-related conditions (8.5%). Age ≥80 years (odds ratio [OR]=1.63; P=0.01) and hypertension (OR=2.08; P<0.001) were risk factors for readmission. Bilateral simultaneous TKA (OR=0.42; P=0.005) was associated with lower risk of readmission. The readmission rate in this study was 3.4%, comparable to rates in previous reports. Enhanced patient education and optimised perioperative pain management are needed to minimise hospital readmissions. Fall prevention, cautious painkiller prescribing, and improved nursing care are recommended to prevent readmission.

The prevalence of threatened miscarriage in Malta

A retrospective cohort study was conducted in Malta to assess the prevalence of threatened miscarriage. The study focuses on cases managed at a local state hospital over a 12-month period. Currently, data on pregnancies prior to 22 weeks’ gestation are not publicly available, which hampers understanding of the frequency and impact of threatened miscarriage. This research provides the basis for a potential prospective study which analysis the epidemiology and outcomes of threatened miscarriage and advocates for early intervention and appropriate patient counselling. The study included females who visited the Accident and Emergency Department in a local state hospital in 2019 with first trimester vaginal bleeding. It excluded patients with incomplete medical records. Data from various hospital departments were collected, anonymised and analysed to track outcomes such as miscarriage, ongoing pregnancy, ectopic or molar pregnancy. The research aimed to create a comprehensive local registry of pregnancy outcomes following threatened miscarriage, reflecting the national situation. In 2019, 711 pregnant women in Malta experienced first-trimester vaginal bleeding. Of these, 241 had successful births beyond 22 weeks’ gestation, while 412 experienced miscarriages, with other outcomes including ectopic and molar pregnancies and 58 women had an unknown pregnancy outcome. A significant association was found between maternal age and risk of miscarriage, particularly higher for women aged 35–46 and those under 19. Birthweight data revealed that threatened miscarriage complications likely led to low birthweights in a significant proportion of newborns. This study analysed pregnancy outcomes which were preceded by first trimester vaginal bleeding in pregnant women in Malta. Establishing a local register of pregnancy outcomes following first trimester vaginal bleeding provides clinicians with enhanced insights into the current local context. This resource may improve patient counselling and informed policy decisions and lay the groundwork for future research in the field.

Assessing Clinicians' Documentation of Vision in Older Adults Who Presented With a Fall at the Accident and Emergency Department of Northampton General Hospital.

Background Falls among elderly adults are one of the most common reasons that could lead to injury and modality, as vision is one of the modifiable risk factors for falls. By assessing it, we can detect those needing further follow-up with opticians or ophthalmologists, lowering the risk of falls secondary to poor vision. Methods Data were collected and reviewed retrospectively from a consecutive list of patients who presented with a fall or head injury to the Accident and Emergency Department at Northampton General Hospital. A total of 180 patients aged 75 years or older were randomly selected between November 2022 and January 2023. This audit measured the vision documentation in the vision assessment tool used in the Emergency Department at Northampton General Hospital and was based on the National Institute for Health and Clinical Excellence (NICE) and the Royal College of Physicians guidelines. Results Out of 180 patients in the sample, 34 (19%) had their visual assessments documented. Among them, around six (17.6%) out of 34 patients had a full vision assessment documenting all the sections in the vision assessment tool. Five (14.7%) out of 34 patients and 11 (32.3%) out of 34 patients did not have documentation about their distance and near vision, respectively. The visual fields were not documented in 22 (64.7%) out of 34 patients, and no assessment of the eye movements was reported in 16 (47%) out of 34 patients. Discussion Most of the patients in the Emergency Department lacked visual documentation, resulting in low compliance with the standards. One of the factorsthat contribute to elderly people's falling is low vision. Uncorrected refractive errors are one of the main causes of poor vision, but their correction is also associated with an increased risk of falls among elderly patients, as they require more time to adapt to changes in prescription (e.g., new glasses). In addition, patients who suffer from some eye conditions, such as glaucoma or macular degeneration, also have a high incidence of falls caused by an impairment of the visual fields. Conclusions All patients over 75 years old who presented with a fall to the Emergency Department should have a vision assessment. Vision documentation is essential to identify patients with vision impairment needing to receive an eye assessment after their discharge to reduce the risk of falls derived from poor vision. Strategies to improve this include training and the dissemination of information (for example, posters), which could help increase documentation rates.

Treatment with medication for patients with psychosis within 2 days during waiting in the accident and emergency department and its correlation with length of in-patient stay: retrospective database study.

One of the 'critical goals' for psychiatric liaison services is reducing hospitalisation. Psychotropic medication is a treatment for psychosis, although research determining the efficacy of early medication administration is lacking. To determine whether commencing psychotropic medication within 2 days of psychiatric liaison input in the accident and emergency (A&E) department is correlated with length of in-patient psychiatric admissions for patients with psychosis. We gathered data on patients presenting to A&E sites covered by South London and Maudsley (SLaM) National Health Service Trust, who were subsequently admitted to and discharged from SLaM psychiatric in-patient wards with discharge diagnosis of psychosis between 2015 and 2020. The analysis set comprised 228 patients waiting in the A&E department under psychiatric liaison care for ≥2 days, of which 140 were started on medication within those 2 days (group A) and 88 were not (group B). Group A was divided into A1 (patients restarted on previous psychotropic medication taken within 1 week) and A2 (others, including those new to psychotropic medication or with past usage). Although Kaplan-Meier survival curves with log-rank tests demonstrated no statistically significant difference of in-patient admission duration between groups A and B or groups B1 and B2, further analysis revealed that subgroup A1 had statistically significant shorter admissions than group B (P = 0.05). Restarting patients with psychosis on medication they were taking within the week before A&E department attendance, within 2 days of arrival at the A&E department, is associated with statistically significant shorter admissions. The limitation is a relatively small sample size.

Giant cellulitis-like Sweet syndrome mimicking cellulitis: a case report

BackgroundSweet syndrome (acute febrile neutrophilic dermatosis) is an uncommon inflammatory disorder characterized by the abrupt appearance of painful, edematous, and erythematous papules, plaques, or nodules on the skin. There are various subtypes, such as classical, drug-induced, malignancy-associated, and the less common variant giant cellulitis-like Sweet syndrome. This case is unique due to its presentation of the giant cellulitis-like variant of Sweet syndrome in a patient from Ethiopia. The unusual distribution of the skin lesions and the initial lack of response to antibiotics make this case particularly noteworthy. It underscores the importance of considering Sweet syndrome in differential diagnoses when faced with atypical skin manifestations and ineffective antibiotic treatment. This contribution adds valuable insights to the scientific literature by highlighting the need for heightened awareness of this rare variant and improving diagnostic accuracy in similar clinical scenarios.Case presentationA 60-year-old Ethiopian male patient who presented to the accident and emergency department with a 5-day history of fever, chills, sweating, and rigor accompanied by a reddish skin color change around the anterolateral region of the right chest wall. On physical examination, there were erythematous, indurated tender plaques with ill-defined borders over the right antero- and posterolateral chest wall with extension to the lateral part of the right neck and medial aspect of the right arm. Subsequently, the patient was started on antibiotics, but there was a suboptimal response. Skin biopsy revealed features suggestive of giant cellulitis-like Sweet syndrome. He was then started on steroids, which significantly improved his symptoms.ConclusionA cautious stance is essential when identifying Sweet syndrome in individuals displaying erythematous plaque-like skin lesions in atypical areas of the body with uneven distribution. Such presentation may signal Sweet syndrome rather than a common infection. If conventional treatments, such as antibiotics, fail to resolve symptoms, consider Sweet syndrome as a potential diagnosis. This approach ensures timely and appropriate treatment, preventing treatment delay and misdiagnosis.

Accident and emergency consultations for head injuries in older adults.

Head injuries are a common reason for hospitalisation, and patients often arrive via accident and emergency departments. This study aimed to investigate changes in accident and emergency consultations due to head injuries for patients ≥50 years. Electronic reimbursement claims by accident and emergency doctors for. In the age group ≥50 years, the overall consultation rate in accident and emergency departments increased from 21674 per 100000 inhabitants in 2006 to 22444 in 2023. The consultation rate for head injuries increased from 92 to 270 per 100000 inhabitants. For the age group 50-66 years, the increase was from 83 to 166, for the age group 67-79 years from 86 to 269, for the age group 80-89 years from 138 to 698, and for the age group ≥90 years from 277 to 1420. Accident and emergency consultations due to head injuries increased in all age groups ≥50 years. Among patients ≥90 years, the consultation rate was more than five times higher in 2023 compared to 2006.

Association Between Oral Fluoroquinolones and Neuropsychiatric Events: Self-Controlled Case Series With Active Comparator Design.

The evidence of the neuropsychiatric effects associated with fluoroquinolones is mainly supported by case reports. Population-based evidence remains largely limited. We aimed to investigate the association between the use of fluoroquinolones and hospitalization or Accident & Emergency department visits for acute neuropsychiatric events using a self-controlled case series (SCCS) and active comparator to reduce confounding. We conducted a SCCS with a recently described active comparator design using all public outpatient clinics, hospitalization, and Accident and Emergency department records from the Clinical Data Analysis and Reporting System, Hong Kong from 2001 to 2013. Among 166 325 people with an oral fluoroquinolone prescription, 4287 people who had an incident neuropsychiatric event were included. We then estimated the incidence rate ratio (IRR) of acute neuropsychiatric events during periods before and after fluoroquinolone prescription, versus baseline. We repeated the analysis for amoxicillin/clavulanic acid users as an active comparator. We then estimated the comparator-adjusted estimates by dividing the IRR for fluoroquinolone by the IRR for amoxicillin/clavulanic acid. The primary outcome was neuropsychiatric events. Secondary outcomes were psychotic events and cognitive impairment. An increased risk of neuropsychiatric events was observed in the current use of fluoroquinolone [IRR: 2.11 (95% confidence interval (CI): 1.58-2.83)] and 1-7 days after the end of fluoroquinolone prescription [IRR: 1.90 (95% CI: 1.30-2.75)] versus baseline. No increased risk was observed in other risk periods versus baseline. Similar patterns were observed in the current use of amoxicillin/clavulanic acid [IRR: 1.92 (95% CI: 1.19-3.11)] and 1-7 days after the end of fluoroquinolone prescription [IRR: 1.81 (95% CI: 1.11-2.97)] versus baseline. Similar results were found for secondary outcomes. Using the active comparator design, comparator-adjusted estimates were 1.10 (95% CI: 0.63-1.93) in current use of fluoroquinolones and 1.05 (95% CI: 0.57-1.95) in 1-7 days postexposure to fluoroquinolones versus baseline. Although our study showed a higher incidence of neuropsychiatric events in the current use of fluoroquinolones and 7 days after the end of fluoroquinolones prescriptions compared with baseline, a similar temporal pattern was also found for amoxicillin/clavulanic acid users. Using amoxicillin/clavulanic acid as the active comparator, we found no difference in the risk of neuropsychiatric events associated with fluoroquinolone compared with baseline. Therefore, the risk of neuropsychiatric events may not need to influence the decision to prescribe either fluoroquinolones or amoxicillin/clavulanic acid based on the evidence in this study.

An Empirical Investigation of Disability-Related Interpersonal Violence Through an Intersectional Research Paradigm: Methodological Considerations and Implications.

The study uses an econometric approach to disaggregate data on disability-related violence reported in Accident and Emergency departments in London to investigate the extent to which the intersections of gender, ethnicity, and age characteristics of disabled people increase their risk of experiencing interpersonal violence. Our empirical findings suggest that females and older individuals are generally more likely to be interpersonal violence victims. The disability dummy is positive and significant, irrespective of gender or ethnicity. This implies that persons with disabilities are more likely to be victims of interpersonal violence than individuals without disabilities, regardless of gender and ethnicity. The most important discovery concerns the magnitude of the dummy coefficient regarding the disability of individuals. The coefficient is the largest for females of Black origin with disabilities, followed by Asians, with white origin exhibiting the smallest coefficient. This suggests that people with disabilities of Black origin are more likely to experience interpersonal violence than the Asian or white community. The study outcomes provide novel and rigorous empirically validated knowledge of the intersectional vectors of power that impact the risk of experiencing disability-related interpersonal violence while informing the development of intersectionality-based policy approaches to tackling disability-related interpersonal violence.

Knowledge, Attitudes and Practices of Radiologists and Paramedics Towards Accident and Emergency Preparedness and the Role of Biomedical Engineering in Prehospital Emergencies

Purpose: The purposes of this study were to assess the knowledge, attitude, and practice of radiologists and paramedics regarding accident and emergency preparedness in hospitals in the southern region of the Kingdom of Saudi Arabia and how to improve their role. Materials and methods: This was a descriptive, cross‑sectional online survey that was carried out among radiologists and paramedics in the Kingdom of Saudi Arabia. A self-structured, close-ended questionnaire that was administered that consisted of 19 questions was included. The questionnaire validity and reliability were evaluated for vetting and remarks. The questions were circulated through Google Forms, and it was circulated among the study participants through online mode. The data were collected systematically, and SPSS Statistics version 26.0 was used for data analysis Results: There were 139 responses, (77 specialist's radiology and 62 paramedics) participated in the study through Google Forms. In the study group, 84 (61.4%) were know the main steps for emergency response in major emergencies (p-value 0.000). Among the 19 questions used to assess the KAP, 12 questions were significant with a p-value less than 0.05. More than 72.6% agree the Management must be adequately prepared when emergencies and accidents occur. The respondents’ attitude toward emergency preparedness was generally positiveو Only a minority, that is, 43 (30.9%) of the respondents think it is possible for cooperation between radiologists and paramedics to interpret emergency cases and develop treatment plans in the emergency department. Conclusion: The level of knowledge was satisfactory among the radiologists and paramedics with a neutral level of attitudes, practice and knowledge regarding disaster preparedness. Follow-up research is essential to maximize the preparedness of the accident and emergency department.

Utilizing Un-enhanced Chest Computed Tomography Screening for Blunt Trauma Surgery Decisions.

Background Blunt chest trauma is a common and potentially life-threatening condition that requires prompt assessment for potential surgical intervention. Computed tomography (CT) of the chest has emerged as a valuable tool due to its heightened sensitivity and specificity in detecting thoracic injuries compared to conventional chest radiography. Objective This study aims to assess the impact of non-contrast CT chest findings on surgical decision-making and compare these findings with those from chest radiographs. Methods The study was conducted at the Accident and Emergency Department of Medical Teaching Institute, Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan. Patients of all ages and genders who presented with blunt chest trauma were included. Non-contrast CT chest scans were used as an initial screening tool and compared with traditional chest radiographs. Data collected included patient demographics, mechanism of injury, diagnostic findings, and treatment decisions. Imaging was performed using a GE Optima 16-slice scanner (Medsystems Sp. z o.o., Lublin, Poland). Results The study included 246 patients, of whom 210 (85.4%) were males. The most common age group was 50 years or older, comprising 71 (28.9%) of the sample. The predominant mechanism of trauma was road traffic accidents, reported by 188 (76.4%) patients. Hemopneumothorax was detected in 121 (49.2%) patients on CT scans compared to 34 (13.8%) patients on chest radiographs. On chest radiograph, the pneumothorax component was missed in 43 (17.5%) patients, and the hemothorax component was not detected in 21 (8.5%) patients. Patient management included conservative management in 30 (12.2%) cases and surgical intervention in the form of unilateral tube thoracostomy in 173 (70.3%) patients or bilateral tube thoracostomy in 43 (17.5%) patients. Conclusion Our study supports the use of non-contrast CT scans as a reliable diagnostic tool for blunt chest trauma, consistent with current literature. This approach facilitates prompt management decisions, particularly for initiating tube thoracostomy based on findings of pneumothorax and hemothorax. The rarity of mediastinal great vessel trauma further justifies minimizing routine contrast use, thereby enhancing the efficiency of trauma evaluations.

Coinfection of Klebsiella pneumoniae and Aspergillus in a patient with chronic obstructive pulmonary disease post cardiac arrest: a case report

IntroductionChronic obstructive pulmonary disease is a lung condition characterized by chronic respiratory symptoms (breathlessness, cough, and expectoration). In the advanced stages, patients often report to the Accident & Emergency department due to worsening of symptoms. Because of the repeated exposure to corticosteroids during the management of exacerbations, these patients are susceptible to super additional infections. Pulmonary aspergillosis can be divided into three main categories: invasive pulmonary aspergillosis, allergic bronchopulmonary aspergillosis and chronic pulmonary aspergillosis. Aspergillus overlap syndrome is defined as the presence of more than one form of Aspergillus in a single patient. However, coinfection with Klebsiella and pulmonary aspergillosis overlap syndrome is rare and poses a treatment challenge. As per a pub med search, no such case report has been reported in a case of chronic obstructive pulmonary disease.Case reportWe report the case of a 66-year-old male, Punjabi Hindu by ethnicity, who was a reformed smoker with a known case of COPD. He presented with a history of breathlessness (mMRC grade 4) associated with cough with expectoration and wheezing for 15 days and intermittent episodes of hemoptysis for more than 6 months. The examination revealed tachypnea and wheezing throughout the lung fields. He was initially managed with parenteral steroids and frequent nebulization with bronchodilators. On day 5 of hospitalization, the patient experienced worsening of symptoms and cardiac arrest; he was intubated and return of spontaneous circulation was achieved within 5 minutes of cardio pulmonary resuscitation. Tracheal aspirate and culture revealed Aspergillus fumigatus and Klebsiella pneumoniae respectively. He underwent chest CT, which showed features suggestive of allergic bronchopulmonary aspergillosis and invasive pulmonary aspergillosis. He was found to have elevated β-d-glucan, galactomannan, and aspergillus IgE and IgG. Severe pneumonia and pulmonary Aspergillus overlap syndrome were managed with antibiotics, steroids, and antifungals. Over the next 15–20 days, his general condition improved. He was discharged after 45 days of hospitalization and continued on oral corticosteroids, antifungals, and inhaled bronchodilators.ConclusionCoinfection with bacteria and fungi worsens the outcome. Clinicians should be aware of the polymicrobial manifestations and various drug interactions involved. Timely diagnosis aids in better management strategies and improved patient outcomes.

A comparative study between point‐of‐care hemoglobin (capillary samples) and laboratory hemoglobin result (venous samples)

AbstractObjectivePoint‐of‐care tests (POCTs) are commonly utilized in emergency departments. The purpose of this study was to evaluate accuracy and clinical utility of capillary POCT Hemocue (POCT Hcue) in emergency department setting.MethodsThis was a retrospective study. Accident and emergency department attendances ≥18 years old with a capillary POCT Hcue result and a paired venous hemoglobin (Hb) result were eligible. Statistical analyses including Pearson coefficient and Bland–Altman plot were performed to assess the relationship and agreement between capillary POCT Hcue and venous Hb.ResultsOne hundred and seven patients were included in the analysis. 59% were female. 67% of the patients were from triage category 3. Scatter plot revealed a linear relationship between capillary POCT Hcue and venous Hb, with a correlation coefficient calculated to be 0.95. The mean difference was −0.30 on the Bland–Altman plot with the limits of agreement from −1.83 to +1.22.ConclusionCapillary POCT Hcue had acceptable agreement with venous Hb in emergency department setting.

"What you Say Matters": Review of Clinical Outcome of Advanced Medical Directives Between Cancer and Non-cancer Patients in a Chinese Culture Society.

Advance medical directives (AMD) are statements made by individuals indicating the life-sustaining treatment that they would refuse in the future when they lost their mental capacity for medical decisions. While the proposal for the AMD legislation is ongoing locally in Hong Kong SAR, there are limited reviews on the clinical outcomes associated with it. To provide a comprehensive review on clinical outcomes of signed AMD. Retrospective, multi-center study, which includes AMD signed within five cluster hospitals. Records of signed AMD from 1st JAN 2020 to 31st DEC 2022 were retrieved from a central registry. Clinical information of each patient was obtained from the electronic patient record. 456 patients with documented AMD were included in the study. 91.6% of AMD were signed by palliative care (PC) team. Majority (74.6%) of the patients were accompanied by family members or friends when AMD were signed. The concordance rate between the AMD and the medical care received was 89.5%. No patient revoked their AMD. Cancer and non-cancer patients showed similar rates of AMD concordance, frequency of Accident & Emergency Department (AED) visits or acute ward admissions, duration of hospital stays in the 30days before death, and prevalence of receiving invasive or intensive treatments. Our study demonstrated that PC team currently plays a pivotal role in AMD completion, and AMD remains important in ensuring patients' care preferences are executed across different medical conditions. With the upcoming AMD legislation in Hong Kong SAR, adequate promotion and education should be launched.

Epidemiological changes in the pattern of children’s traumatic injuries at Hong Kong emergency departments during the COVID-19 pandemic: a retrospective, single-institutional, serial and comparative study

IntroductionTrauma is the leading cause of paediatric mortality and morbidity. Stay-home regulations for coronavirus disease 2019 (COVID-19) reportedly changed trauma severity, yet data from Hong Kong were lacking. This study examined Hong Kong’s spectrum of paediatric trauma and addressed knowledge gaps concerning epidemiological changes during COVID-19.MethodsChildren with traumatic injuries who attended a tertiary trauma centre from January 2010 to March 2022 were included in this retrospective, cross-sectional study. We analysed demographic and clinical data and conducted unadjusted bivariate analyses of injury patterns before and after the pandemic.ResultsIn total, 725 children attended the Accident and Emergency Department due to trauma, 585 before and 140 during COVID-19. The male-to-female ratio was 1.84:1. The 90-day trauma-related mortality was 0.7%. The overall Injury Severity Score was 3.52 ± 5.95. The paediatric trauma incidence was similar before and after social-distancing policies (both 5.8 cases monthly). Gender, ISS distribution, intensive care unit stay length, and hospital stay length values were similar (p > 0.05). Trauma call activation (8.4% vs. 5.7%, p = 0.002) and road traffic accidents (10.6% vs. 5.7%, p = 0.009) significantly decreased, yet younger-patient injuries (< 10 years old; 85.7% vs. 71%, p < 0.001), burns (28% vs. 45.7%, p < 0.001), and domestic injuries (65.5% vs. 85.7%, p < 0.001) significantly increased. No significant self-harm, assault, or abuse increases were found.ConclusionsThe paediatric trauma incidences were similar before and during the pandemic. However, domestic and burn injuries significantly increased, highlighting the importance of injury prevention.

Factors influencing the use of Point Of Care Ultrasound (POCUS) on adult patients by Accident and Emergency Department (A&amp;amp;E) Doctors in Tertiary Care Hospitals in Colombo District, Sri Lanka; a Descriptive Cross-Sectional Study

Introduction:Point of care ultrasound (PoCUS) is an essential component of A&amp;E setting all over the world. It is used for diagnosis and assisting bedside procedures. Usage of PoCUS has been shown to improve quality of patient care. There are no formal studies in Sri Lankan A&amp;E setting to assess level of its usage and the barriers of using it. This study aimed to assess these aspects among ED doctors in three tertiary care hospitals in Colombo district.Methodology:This descriptive study was conducted by self-administered questionnaires distributed among 72 ED doctors working in the above setting. Questionnaire consisted of questions related to sociodemographics, types of PoCUS performed, barriers to PoCUS use etc. Ability to perform PoCUS was assessed by Likert grading from 1 to 5 based on operator’s own opinion. Statistical analysis was done using SPSS.Results: All the tertiary care emergency services had access to an ultrasound machine. PoCUS has been used for a wide variety of bedside scans and therapeutic procedures. Majority has been used to detect free fluid in peritoneal cavity (66.6%) and FAST scans (65.3%). Post graduate doctors (PG) were more confident in configuring PoCUS machine for procedures than non PG doctors (82.8% vs 5.4%). Ability to perform PoCUS was associated with post graduate exposure, &gt;1 year of experience using it and doing &gt;300 procedures in last 3 months (p=0.001). Main barriers identified for PoCUS usage were lack of training and lack of quality ultrasound machine.Discussion: Though PoCUS is mainly performed by PG doctors, important scans such as FAST, intra peritoneal free fluid assessment are done by non-PG doctors too. Compared to similar international studies, less number of latter doctors were capable of doing PoCUS in Sri Lanka. Empowering these doctors with PoCUS skills will improve the sustainably of this service in emergency care setup as they work in units for longer duration. A study where candidates’ skills are assessed by a third party would have provided more accurate reflection of PoCUS usage.Conclusion: Embracing updated technology and further improvement and availability of PoCUS training among ED doctors will enhance sustainable emergency patient care in Sri Lanka.

The Role of Trending Shock Index Paediatric Adjusted (SIPA) in Paediatric Trauma as a Predictor of Morbidity and Mortality

Abstract Background and Purpose There are several injury scoring systems, anatomic, physiologic and combined scores, which have been used for prediction of patients' outcome such as mortality. Among physiologic scoring systems evolved shock index (heart rate divided by systolic blood pressure) which has been first described in 1967. In the world of paediatric and due to the physiological differences between different age groups, few adjustments have to be done considering these changes evolving shock index paediatric adjusted (SIPA). This study was conducted to evaluate SIPA as a quick feasible method for triaging and managing pediatric trauma and also to predict ICU admission and need for CT scan as a primary outcome and also secondary outcomes like length of hospital stay and (need for surgical intervention) and mortality rate. Study Design Prospective randomized controlled study. Setting The children’s accident and emergency department in Armed Forces Hospitals and Ain Shams University hospitals. Subjects We included 124 pediatric trauma children, and they were divided into 2 groups: Group A (62 children): assessed by SIPA in an incidence of trauma, and Group B (62 children): assessed by traditional vital signs (blood pressure, pulse and capillary refill). Methods All patients were subjected to full history taking, SIPA assessment on admission and its daily changes (baseline up to 48 hours). Assessment for need for ICU admission, ventilation, CT scan, surgical intervention, and Length of hospital stay, along with mortality rate recording. Results In the studied population, the mean age of all patients was (6.8 ± 3.2) years, with (65.3%) of patient males; and (34.7%) females. Regarding outcome data, comparative study between the 2 groups revealed; significant decrease in ICU admission, need for CT scan, LOS and mortality rate in Group A (SIPA) (p &amp;lt; 0.05). As regards SIPA trend, we found non-significant difference between mortality and no-mortality subgroups in SBP, heart rate, Capillary refill time and SIPA during the serial (baseline up to 48-h) measurements. Also, regarding ICU LOS, we found non-significant difference between mortality and no-mortality subgroups in SBP, heart rate, Capillary refill time and SIPA during the serial (baseline up to 48-h) measurements. Conclusion To conclude, SIPA score proven to be an accurate and specific predictor of morbidity, hospital stay and ICU admission, and mortality rate in pediatric trauma patients and is superior to capillary refill time, tachycardia or hypotension alone for predicting different outcomes.

Emergency Hospital Admissions of Elderly Patients with Dementia: General Characteristics, Outcome, and Areas of Improvement at an Accident and Emergency Department

Aim: Age-related disorders, such as dementia, are relevant for healthcare services and health systems worldwide. The prevalence of dementia across European countries is estimated to exceed 7 %, and may rise over time. Those patients are at increased risk for hospital admission and prolonged hospitalization, and such care increases the cost for the healthcare system. Less is known regarding patients with dementia in Greece that visit the Accident and Emergency departments (A&amp;E) in general hospitals. The present retrospective study aimed to address this issue. Subjects and methods: The sample of patients and the control group were traced in the A&amp;E department of the University Hospital of Ioannina, Northwest Greece. The study sample consisted of 100 patients with dementia, aged &gt; 65 years and 100 matched controls. The median age of patients with dementia was 85 years, for the control group 83 years, and 63 % were females. In most cases the diagnosis had been made by primary care physicians, and in of patients 21 % by neurologists/psychiatrists. Results: In both groups a median of 2 comorbidities was recorded, with hypertension, heart failure and dyslipidaemia being the most common. Fever and falls were the most common reasons for dementia patients visiting the A&amp;E department. Infection was the most common diagnosis in dementia patients, whereas in 17 % of cases no diagnosis was made and no interventions were needed. The probability of admission after an A&amp;E visit was significantly higher for the dementia group, whereas there were no differences regarding length of hospital stay between patients and controls. Conclusions: The results of the study are in line with international research and highlight the need for the establishment of a national register for patients with dementia, that would enable information exchange between primary and tertiary care and would enable proper diagnosis, management and discharge arrangements.