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Cheung KH, Ong YS, Graham CA, Rainer TH, Cheung NK. Use of point-of-care ultrasound (POCUS) by emergency physicians for general surgical patients in resuscitation room. Crit Ultrasound J 2014. [PMCID: PMC4101547 DOI: 10.1186/2036-7902-6-s1-a20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rainer TH, Yeung JHH, Cheung SKC, Yuen YKY, Poon WS, Ho HF, Kam CW, Cattermole GN, Chang A, So FL, Graham CA. Assessment of quality of life and functional outcome in patients sustaining moderate and major trauma: a multicentre, prospective cohort study. Injury 2014; 45:902-9. [PMID: 24314871 DOI: 10.1016/j.injury.2013.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 10/29/2013] [Accepted: 11/10/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trauma care systems aim to reduce both death and disability, yet there is little data on post-trauma health status and functional outcome. OBJECTIVES To evaluate baseline, discharge, six month and 12 month post-trauma quality of life, functional outcome and predictors of quality of life in Hong Kong. METHODS Multicentre, prospective cohort study using data from the trauma registries of three regional trauma centres in Hong Kong. Trauma patients with an ISS≥9 and aged≥18 years were included. The main outcome measures were the physical component summary (PCS) score and mental component summary (MCS) scores of the Short-Form 36 (SF36) for health status, and the extended Glasgow Outcome Scale (GOSE) for functional outcome. RESULTS Between 1 January 2010 and 31 September 2010, 400 patients (mean age 53.3 years; range 18-106; 69.5% male) were recruited to the study. There were no statistically significant differences in baseline characteristics between responders (N=177) and surviving non-responders (N=163). However, there were significant differences between these groups and the group of patients who died (N=60). Only 16/400 (4%) cases reported a GOSE≥7. 62/400 (15.5%) responders reached the HK population norm for PCS. 125/400 (31%) responders reached the HK population norm for MCS. If non-responders had similar outcomes to responders, then the percentages for GOSE≥7 would rise from 4% to 8%, for PCS from 15.5% to 30%, and for MCS from 31% to 60%. Univariate analysis showed that 12-month poor quality of life was significantly associated with age>65 years (OR 4.77), male gender (OR 0.44), pre-injury health problems (OR 2.30), admission to ICU (OR 2.15), ISS score 26-40 (OR 3.72), baseline PCS (OR 0.89), one-month PCS (OR 0.89), one-month MCS (OR 0.97), 6-month PCS (OR 0.76) and 6-month MCS (OR 0.97). CONCLUSION For patients sustaining moderate or major trauma in Hong Kong at 12 months after injury<1 in 10 patients had an excellent recovery, ≤3 in 10 reached a physical health status score≥Hong Kong norm, although as many as 6 in 10 patients had a mental health status score which is≥Hong Kong norm.
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Rainer TH, Cattermole GN, Graham CA, Chan SSW. Anthropometric and physiological measurements in healthy children. Hong Kong Med J 2013; 19 Suppl 9:26-29. [PMID: 24473586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
1. Normal ranges for ultrasonic cardiac output monitor-derived cardiovascular indices are derived for Chinese children aged 1 to 12 years in Hong Kong. 2. A simple formula for calculating stroke volume is constructed, but the error varies from 8 to 40%. 3. Stroke volume index and, to a lesser extent, the cardiac index generally increase from ages 1 to 5 years, but plateau or fall slightly thereafter.
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Ma HM, Ip M, Woo J, Hui DSC, Lui GCY, Lee NLS, Chan PKS, Rainer TH. Risk factors for drug-resistant bacterial pneumonia in older patients hospitalized with pneumonia in a Chinese population. QJM 2013; 106:823-9. [PMID: 23853031 DOI: 10.1093/qjmed/hct152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The relationship between healthcare-associated pneumonia (HCAP) and resistant bacteria is unclear. The aim of this study was to identify the risk factors for pneumonia caused by drug-resistant bacteria (DRB). METHODS A prospective cohort study was conducted at a tertiary teaching hospital in Hong Kong. Consecutive older patients (aged ≥65 years) were hospitalized with pneumonia from January 2004 to June 2005. DRB comprised methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae and Acinetobacter baumannii. RESULTS The entire cohort consisted of 1176 older patients. Of 472 (40.1%) patients with etiological diagnosis established, bacterial pneumonia was found in 354 (30.1%) cases. DRB were isolated in 48 patients: P. aeruginosa (41), MRSA (5) and ESBL producing enteric bacilli (3). Co-infection with P. aeruginosa and MRSA was found in one patient. The prevalence of DRB in culture-positive pneumonia was 20.1% (48/239). Patients with DRB were more likely to have limitation in activities of daily living, bronchiectasis, dementia, severe pneumonia, recent hospitalization and recent antibiotic use. Logistic regression revealed that bronchiectasis [relative risk (RR) 14.12, P = 0.002], recent hospitalization (RR 4.89, P < 0.001) and severe pneumonia (RR 2.42, P = 0.010) were independent predictors of drug-resistant bacterial pneumonia. CONCLUSION Recent hospitalization is the only risk factor for HCAP which is shown to be associated with DRB. Nursing home residence is not a risk factor. The concept of HCAP may not be totally applicable in Hong Kong where the prevalence of drug-resistant pathogens in pneumonia is low.
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Cattermole GN, Liow ECH, Graham CA, Rainer TH. THERM: the Resuscitation Management score. A prognostic tool to identify critically ill patients in the emergency department. Emerg Med J 2013; 31:803-7. [DOI: 10.1136/emermed-2013-202772] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gralnek IM, Ching JYL, Maza I, Wu JCY, Rainer TH, Israelit S, Klein A, Chan FKL, Ephrath H, Eliakim R, Peled R, Sung JJY. Capsule endoscopy in acute upper gastrointestinal hemorrhage: a prospective cohort study. Endoscopy 2013; 45:12-9. [PMID: 23254402 DOI: 10.1055/s-0032-1325933] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Capsule endoscopy may play a role in the evaluation of patients presenting with acute upper gastrointestinal hemorrhage in the emergency department. PATIENTS AND METHODS We evaluated adults with acute upper gastrointestinal hemorrhage presenting to the emergency departments of two academic centers. Patients ingested a wireless video capsule, which was followed immediately by a nasogastric tube aspiration and later by esophagogastroduodenoscopy (EGD). We compared capsule endoscopy with nasogastric tube aspiration for determination of the presence of blood, and with EGD for discrimination of the source of bleeding, identification of peptic/inflammatory lesions, safety, and patient satisfaction. RESULTS The study enrolled 49 patients (32 men, 17 women; mean age 58.3 ± 19 years), but three patients did not complete the capsule endoscopy and five were intolerant of the nasogastric tube. Blood was detected in the upper gastrointestinal tract significantly more often by capsule endoscopy (15 /18 [83.3 %]) than by nasogastric tube aspiration (6 /18 [33.3 %]; P = 0.035). There was no significant difference in the identification of peptic/inflammatory lesions between capsule endoscopy (27 /40 [67.5 %]) and EGD (35 /40 [87.5 %]; P = 0.10, OR 0.39 95 %CI 0.11 - 1.15). Capsule endoscopy reached the duodenum in 45 /46 patients (98 %). One patient (2.2 %) had self-limited shortness of breath and one (2.2 %) had coughing on capsule ingestion. CONCLUSIONS In an emergency department setting, capsule endoscopy appears feasible and safe in people presenting with acute upper gastrointestinal hemorrhage. Capsule endoscopy identifies gross blood in the upper gastrointestinal tract, including the duodenum, significantly more often than nasogastric tube aspiration and identifies inflammatory lesions, as well as EGD. Capsule endoscopy may facilitate patient triage and earlier endoscopy, but should not be considered a substitute for EGD.
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Lee N, Chan PKS, Rainer TH, Hui D, Choi KW, Cockram CS. Influenza virus load in hospitalised patients. Hong Kong Med J 2013; 19 Suppl 4:15-18. [PMID: 23775181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
1. Hospitalised patients with severe influenza have persistently high viral loads, for whom a different therapeutic approach may be needed. 2. Active screening of influenza infection should be performed in all high-risk patients hospitalised with febrile respiratory illness. Early diagnosis and treatment to suppress the high viral load may maximise clinical benefit. 3. For late presenting high risk patients with severe symptoms, their viral load may remain high, and initiation of antiviral treatment may still be worthwhile. 4. More stringent infection control measures, including strict droplet precautions and preferably isolation for an extended period of time may be necessary owing to prolonged viral shedding. 5. Randomised, controlled trials are indicated to address timing and dosage of treatment for severe influenza infection.
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Cattermole GN, Leung PYM, Graham CA, Rainer TH. Too tall for the tape: the weight of schoolchildren who do not fit the Broselow tape. Emerg Med J 2013; 31:541-544. [DOI: 10.1136/emermed-2012-202325] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 02/12/2013] [Accepted: 03/17/2013] [Indexed: 01/25/2023]
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Chan SSW, Cattermole GN, Leung MPY, Ho GYL, Graham CA, Rainer TH. Children's Discomfort during Noninvasive Cardiac Output Monitoring by Suprasternal Ultrasonographic Transducer. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objectives To investigate the level of discomfort/pain in children receiving Ultrasonic Cardiac Output Monitoring (USCOM), as compared to blood pressure measurement. Methods Healthy children, aged 3-12 years old, were recruited from kindergartens and schools as a part of the “Healthy children's vital signs and USCOM values” project. Oscillometric blood pressure was measured, followed by USCOM measurement. The discomfort experienced by the child during each intervention was assessed using the Wong-Baker FACES pain rating scale. The pain scores (scale from 0-5) were compared using Wilcoxon signed rank test. A difference in score of one point was considered to be clinically relevant. Gender differences in pain score were analysed using Mann-Whitney-U test. Results A total of 254 subjects (131 boys, 123 girls) were included. Mean age was 7.9 years with standard deviation (SD) of 2.4 years. The median pain score for USCOM measurement was 1.0 (95% CI=1.0 to 2.0) with interquartile range 1.0 to 2.0. The median pain score for BP measurement was 1.0 (95% CI,=1.0 to 1.0) with interquartile range 0.0 to 2.0. Overall, the pain score associated with USCOM was significantly higher than that associated with BP measurement. However, the difference fails to reach the minimum clinically significant difference of one-point. No significant difference was shown between boys and girls. Conclusion USCOM appears to be tolerated well by healthy children. The discomfort reported during USCOM measurement is comparable to that associated with blood pressure measurements.
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Chor JSY, Pada SK, Stephenson I, Goggins WB, Tambyah PA, Medina M, Lee N, Leung TF, Ngai KLK, Law SK, Rainer TH, Griffiths S, Chan PKS. Differences in the compliance with hospital infection control practices during the 2009 influenza H1N1 pandemic in three countries. J Hosp Infect 2012; 81:98-103. [PMID: 22560251 DOI: 10.1016/j.jhin.2012.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/03/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND In December 2009, the World Health Organization (WHO) issued updated guidelines on the prevention of H1N1 influenza virus in healthcare settings. In 2010, the WHO pandemic influenza alert level was still at phase 6. AIM To study the practice of infection control measures during the 2009 influenza H1N1 pandemic among healthcare workers (HCWs) in three countries. METHODS A standardized, self-administered anonymous questionnaire survey was conducted in 2010 among doctors, nurses and allied HCWs in 120 hospital-based clinical departments in Hong Kong, Singapore and the UK. Questions were asked on demographics; previous experience and perceived severity of influenza; infection control practices; uptake of seasonal influenza vaccination and H1N1 vaccination. Multiple logistic regression was used to test the independent association with different factors. FINDINGS A total of 2100 HCWs in the three countries participated. They reported high compliance (>80%) with infection control procedures regarded as standard for droplet-transmitted infections including wearing and changing gloves, and washing hands before and after patient contact. However, the reported use of masks with indirect or direct patient contact (surgical or N95 as required by their hospital) varied considerably (96.4% and 70.4% for Hong Kong; 82.3% and 87.7% for Singapore; 25.3% and 62.0% for the UK). Reported compliance was associated with job title, number of patient contacts and perceived severity of pandemics. There was no association between the uptake for seasonal or 2009 H1N1 vaccines and compliance. CONCLUSIONS Compliance with infection control measures for pandemic influenza appears to vary widely depending on the setting.
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Rainer TH, Sollich P, Piotrowski T, Coolen ACC, Cheng B, Graham CA. Evaluating acute medical admissions through emergency departments in Hong Kong: can one adjust for case-mix variation? Emerg Med J 2012; 29:978-82. [PMID: 22389353 DOI: 10.1136/emermed-2011-200996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare systems are under pressure to efficiently and safely reduce acute care admissions to hospital. There is a need to develop a standardised system for assessing emergency department performance which takes into account case-mix variation. The objective of this study was to derive and validate a standardised tool for assessing variations in medical admissions through emergency departments in Hong Kong. METHODS Retrospective study of patients attending emergency departments of 14 acute hospitals in Hong Kong. Data were retrieved from a centralised administrative database. RESULTS Of 2,531,225 patients who attended emergency departments between 1 January 2001 and 31 December 2003, 780,444 (30.8%) were admitted to medical wards. A model derived from 2001 data shows well-calibrated admission probabilities, with an area under the receiver operating characteristic curve for probability of admission of 90.3 (95% CI ±0.11). The areas under the receiver operating characteristic curves for 2002 and 2003 validation sets were 89.9 (95% CI ±0.11) and 89.0 (95% CI ±0.12), respectively. With an averaged benchmark, reductions in medical admissions of up to 19% could be achieved, while under the most optimistic assumption, reductions of up 36% could be achieved. CONCLUSIONS A tool for benchmarking hospital medical admissions and minimising case-mix variation has been derived and validated in Hong Kong, but it requires further validation in other healthcare systems given the wide variations in admission thresholds internationally. This may be used as one potential method to evaluate the performance of emergency departments against a common standard.
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Rashid H, Abdel-Moniem A, Email S, El-Batran M, Rashid H, Mansour H, Mahmoud S, Ashour Z, Mustafa S, Khodeer SA, Abdu-Allah AM, Al-Assal M, Rashid HK, Ghosh Dastidar A, Garg P, West J, Muthusamy R, Gunn J, Zhu F, Lee A, Chee YE, Li ZJ, Kang CS, Chen ZY, Zhang YX, Zhao ZX, Song Q, Rong Y, Bao W, Shan ZL, Rong S, Wang D, Yao P, Liu LG, Zhu LX, Ho SC, Ruan GQ, Xie Q, Sit JWH, Yang YL, Chan MCH, Hu M, Chan TYK, Tomlinson B, Wu HS, Wang LS, Qin J, Wong TT, Heng PA, Yu CM, Luis SA, Luis CR, Habibian M, Courtney A, Hamilton-Craig C, Strugnell W, Poon K, Slaughter R, Raffel OC, Raffel OC, Luis SA, Hansen M, Slaughter R, Hamilton-Craig C, Liang Y, Bai Y, Chen T, Feng GX, Yang YM, Wang XY, Yang YJ, Zhu J, Al-Mohammadi M, Hersi A, Alhabib KF, Alsheikh-Ali AA, Sulaiman K, Alfaleh H, Alsaif S, Almahmeed W, Asaad N, Amin H, Al-Motarreb A, Al-Suwaid J, Blanco JRF, Velasco AB, Mancera J, Francisco A, CA, Zhuravlyova L, Lopina N, Song HH, Xu SH, Huang MZ, Xu CS, Xie LD, Ko B, Cameron J, Seneviratne S, Leung M, Antonis P, Koutsoubos J, Malaiapan Y, Meredith I, Capros N, Istrati V, Matcovschi S, Dumitras T, Istrati S, Nicolenco I, Hotineanu R, Manea D, Gherman O, Hsiung MC, Ko CH, Wei J, Tung TH, Graham CA, Chan JWM, Rotherary KR, Rainer TH, Yan B, Liu M, Huang XR, Li RJ, Lam YY, Yu CM. P033 * Evaluation of myocardial function in patients with chronic stable angina and apparent normal ventricular function (tissue doppler study before and after PCI). Eur Heart J Suppl 2012. [DOI: 10.1093/eurheartj/sur025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Liu Y, Pan L, Zhang ZN, Shi ZH, Wang Y, Jing ZC, Lee WY, Chan MC, Cheun TK, So KH, Yu CM, Lee WY, Pang TY, Kong WY, Chan KH, Kwok LM, Chan SW, Ko SSW, Tam CWY, Fok BSP, Hu M, Yin OQP, Chow MSS, Tomlinson B, Guo ZR, Wu M, Zhang LJ, Luo WS, Liu JC, Ding Y, Zhu QR, Chen Q, Chan SSW, Ahmad I, Graham CA, Rainer TH, Berdina ON, Madaeva IM, Dolgikh VV, Xie MX, Li YM, Gao X, Wang GY, Wang AL, Xu T, Tong WJ, Zhang YH, Pogodina AV, Dolgikh VV, Moretzkaya IS, Nawaz SK, Xu JB, Zhang YL, Liu Y, Huang G, Zhang TJ, Huang XB, Ou YLY, Chan SSW, Tse MM, Chan CPY, Graham CA, Rainer TH, Wong MCS, Yan B, Tam WWS, Wang HHX, Liu KSD, Liu KQ, Cheung CSK, Tong ELH, Sek ACH, John GK, Cheung NT, Yu CM, Leeder S, Griffiths S, Wang HHX, Wong MCS, Yan B, Tang JL, Wang JJ, Yu CM, Griffiths S, Wong MCS, Yan B, Tam WWS, Wang HHX, Liu KSD, Liu KQ, Cheung CSK, Tong ELH, Sek ACH, Cheung NT, Yu CM, Leeder S, Griffiths S, Shin SH, Woo SI, Kim DH, Park KS, Kwan J, Liu KQL, Wong MCS, Wang HHX, Liu KSD, Yan B, Yu CM, Griffiths S, Borumand H, Cheang IN, Law TC, Choi SKV, Chung LH, Chan SLD, Li YC, Choy PS, Hung YKS, Cheung YHK, Chan LH, Chan KHK. P077 * Evaluation of two-dimensional strain echocardiography in quantifying right ventricular function in patients with pulmonary hypertension. Eur Heart J Suppl 2012. [DOI: 10.1093/eurheartj/sur028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Wong EML, Rainer TH, Ng YC, Chan MS, Lopez V. Cost-effectiveness of Dermabond versus sutures for lacerated wound closure: a randomised controlled trial. Hong Kong Med J 2011; 17 Suppl 6:4-8. [PMID: 22147351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
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Mitra B, Rainer TH, Cameron PA. Predicting massive blood transfusion using clinical scores post-trauma. Vox Sang 2011; 102:324-30. [PMID: 22092220 DOI: 10.1111/j.1423-0410.2011.01564.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Early prediction of massive transfusion (MT) post-trauma may reduce mortality by earlier delivery of blood products. A clinical prediction tool (PWH score) for this purpose was developed at the Prince of Wales Hospital, Hong Kong. The aims of this study were to apply this tool to major trauma patients in Victoria, Australia and compare the score to the Assessment of Blood Consumption (ABC) score and the Trauma-Associated Severe Haemorrhage (TASH) score. METHODS A retrospective review of patients entered into the The Alfred Trauma Registry between January 2006 and December 2009 was conducted. The performance of the PWH score to predict MT defined by 5 units of packed red blood cells in 4 h was compared with the ABC and TASH scores. Included patients presented to the Emergency & Trauma Centre from the scene and had had complete datasets with respect to the components of the three scores. RESULTS There were 1234 patients included in the study with 195 (15·8%) receiving a MT and an overall mortality of 14·0%. The PWH score had an area under the receiver operating characteristics (ROC) curve of 0·842 (95% CI: 0·820-0·862). The area under the ROC curve of the PWH score was significantly less than that of the TASH score (χ(2)=19·8, P<0·001) and significantly greater than that of the ABC score (χ(2)=9·3, P=0·002). CONCLUSIONS The PWH score performs with similar accuracy when applied to an Australian population as in its derivation population. The relative simplicity of the PWH score makes it a viable tool for clinical use, although utility of such tools may be more suited for research in determining inclusion or exclusion criteria for comparative outcome studies.
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Rotheray KR, Cheung PSY, Cheung CSK, Wai AKC, Chan DYS, Rainer TH, Graham CA. What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population? Resuscitation 2011; 83:86-9. [PMID: 21787740 DOI: 10.1016/j.resuscitation.2011.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 06/20/2011] [Accepted: 07/16/2011] [Indexed: 11/18/2022]
Abstract
AIM To describe the relationship of gag and cough reflexes to Glasgow coma score (GCS) in Chinese adults requiring critical care. METHOD Prospective observational study of adult patients requiring treatment in the trauma or resuscitation rooms of the Emergency Department, Prince of Wales Hospital, Hong Kong. A long cotton bud to stimulate the posterior pharyngeal wall (gag reflex) and a soft tracheal suction catheter were introduced through the mouth to stimulate the laryngopharynx and elicit the cough reflex. Reflexes were classified as normal, attenuated or absent. RESULTS A total of 208 patients were recruited. Reduced gag and cough reflexes were found to be significantly related to reduced GCS (p=0.014 and 0.002, respectively). Of 33 patients with a GCS≤8, 12 (36.4%) had normal gag reflexes and 8 (24.2%) had normal cough reflexes. 23/62 (37.1%) patients with a GCS of 9-14 had absent gag reflexes, and 27 (43.5%) had absent cough reflexes. In patients with a normal GCS, 22.1% (25/113) had absent gag reflexes and 25.7% (29) had absent cough reflexes. CONCLUSIONS Our study has shown that in a Chinese population with a wide range of critical illness (but little trauma or intoxication), reduced GCS is significantly related to gag and cough reflexes. However, a considerable proportion of patients with a GCS≤8 have intact airway reflexes and may be capable of maintaining their own airway, whilst many patients with a GCS>8 have impaired airway reflexes and may be at risk of aspiration. This has important implications for airway management decisions.
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Wu RSY, Chan SSW, Cheung NK, Graham CA, Rainer TH. Open-access colonoscopy: outcomes of referrals from the emergency department. Colorectal Dis 2011; 13:826-8. [PMID: 20456463 DOI: 10.1111/j.1463-1318.2010.02301.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM The study investigated the diagnostic outcome of colonoscopy referrals from the emergency department (ED) via an open-access system. METHOD A retrospective cohort study over two years was performed on all patients under 65 years referred for open-access colonoscopy by the ED in a hospital with an annual ED attendance of 140,000. Patient characteristics and presenting symptoms were retrieved. Waiting times from presentation to colonoscopy were recorded. RESULTS Over a 2-year period, 266 patients were referred, of whom 37 defaulted, leaving 229 patients who had a colonoscopy. The mean age was 48.3 ± 11.3 (SD) and the female/male ratio was 229/125. The most frequent presenting symptoms included: rectal bleeding (n = 142, 62%), change of bowel habit (n = 47, 20.5%) and abdominal pain (n = 40, 17.5%). The median waiting time from presentation to colonoscopy was 17 (range 1-69) days. A positive colonoscopic finding was recorded in 45.4%, including colorectal cancer in 12 (5.2%). CONCLUSION The rate of a positive diagnoses from the ED-based colonoscopy referral service was comparable to that of the general Hong Kong population. This approach may help to reduce the waiting time for colonoscopy in a specialist colorectal clinic.
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Yim VWT, Rainer TH, Graham CA, Woo J, Wong TW, Lau FL, Ting SM. Emergency department intervention for high-risk elders: identification strategy and randomised controlled trial to reduce hospitalisation and institutionalisation. Hong Kong Med J 2011; 17:4-7. [PMID: 21673351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Chan SSW, Cattermole GN, Leung PYM, Mak PSK, Graham CA, Rainer TH. Validation of the APLS age-based vital signs reference ranges in a Chinese population. Resuscitation 2011; 82:891-5. [PMID: 21507547 DOI: 10.1016/j.resuscitation.2011.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 02/05/2011] [Accepted: 02/24/2011] [Indexed: 11/30/2022]
Abstract
UNLABELLED Reference ranges for vital signs may differ significantly among children of different ethnic origins. AIM (1) To validate the Advanced Paediatric Life Support (APLS) age-based vital signs reference ranges in Chinese children in Hong Kong. (2) To derive age-based centile curves for systolic blood pressure, heart rate and respiratory rate for Chinese children. (3) To summarize the reference ranges in a table format appropriate for applying APLS to ethnic Chinese patients. METHOD A cross-sectional study was performed on a population of healthy Chinese children recruited from 8 kindergartens and 6 primary schools in Hong Kong. Trained operators visit the sites to obtain measurements. Age-groups: small toddlers (12-23 months); pre-school (24-59 months); and school (60-143 months). Z-test was used to assess statistical significance for proportions of each parameter falling outside the APLS reference range. One-sample t-test was used for comparison with APLS means according to age-groups. LMS Chartmaker Pro v2.3 software was used to describe the data in centile curves. RESULTS A total of 1353 patients (55.1% boys) were included. For heart rate, systolic blood pressure and respiratory rate respectively, 34.1%, 55.9% and 55.7% of corresponding measurements were outside the APLS age-based reference ranges. In the 'pre-school' and 'school' age-groups, the mean value for blood pressure is significantly higher, and the mean values for heart rate and respiratory rate significantly lower, in comparison to APLS mean values. CONCLUSION Independently derived vital signs reference ranges are more appropriate for use when applying APLS to Chinese patients in Hong Kong.
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Man SY, Graham CA, Chan SSW, Mak PSK, Yu AHY, Cheung CSK, Cheung PSY, Lui G, Lee N, Chan M, Ip M, Rainer TH. Disease severity prediction for nursing home-acquired pneumonia in the emergency department. Emerg Med J 2011; 28:1046-50. [DOI: 10.1136/emj.2010.107235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cattermole GN, Leung MPY, So HK, Mak PSK, Graham CA, Rainer TH. Age-based formulae to estimate children's weight in the emergency department. Emerg Med J 2010; 28:390-6. [DOI: 10.1136/emj.2009.090357] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cheung CSK, Mak PSK, Manley KV, Lam JMY, Tsang AYL, Chan HMS, Rainer TH, Graham CA. Predictors of important neurological causes of dizziness among patients presenting to the emergency department. Emerg Med J 2010; 27:517-21. [DOI: 10.1136/emj.2009.078014] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cattermole GN, Graham CA, Rainer TH. Patient satisfaction and healthcare providers. Arch Emerg Med 2010; 27:249. [DOI: 10.1136/emj.2009.079988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hung KKC, Cheung CSK, Rainer TH, Graham CA. EMS systems in China. Resuscitation 2009; 80:732-5. [PMID: 19443099 DOI: 10.1016/j.resuscitation.2009.04.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 04/10/2009] [Indexed: 11/19/2022]
Abstract
The prehospital emergency service is the initial part of the Emergency Medical Service System (EMSS) in China, and is the de facto overall emergency medical service for China. As the EMSS in China continues to undergo rapid development, it faces the challenge of providing rapid response times with adequate coverage for this highly populated country. The recent Sichuan earthquake on 12 May 2008 tested the ability of the EMSS response. This article focuses on the prehospital emergency service of the EMSS and discusses the strengths and weaknesses of the current system.
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Cattermole GN, Graham CA, Rainer TH. Ethics and analgesia. Emerg Med J 2009; 26:389. [PMID: 19386890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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