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Free accessEditorialFirst published April, 2003pp. 67-69
Free accessResearch articleFirst published April, 2003pp. 70-75To study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy.
Retrospective study in a two-month period.
Accident & Emergency Department of a public general hospital, which had four in-patient specialties – Medicine, Surgery, Paediatrics and Orthopaedics.
All cases admitted through the emergency department in the study period.
Degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis.
Of all admission diagnoses, 71.4% fully or partially matched the final discharge diagnoses. The accuracy of diagnosis was statistically better in traumatic cases, the male sex and young adults. Diagnostic accuracy varied with the specialty involved and investigations taken.
History and physical examination remained the most important diagnostic tools in the emergency department. In general, simple investigations available at the emergency department were not helpful in improving diagnostic accuracy.
Free accessResearch articleFirst published April, 2003pp. 76-80Stroke patients often came late to hospital and arrived beyond the therapeutic time window for thrombolytic therapy. We studied the time from stroke onset to arrival at Accident and Emergency (A&E) department and examined what barred them from early medical attendance.
All acute stroke patients attending A&E between 15 March 1999 to 14 June 1999 were recruited. For those brought in by ambulance, their time intervals were divided into three: phase I was between stroke onset to call 999; phase II was between call 999 to A&E arrival; and phase III was between A&E arrival to being seen by doctor. For those who did not come by ambulance, they were divided into two groups: those who consulted other doctors and those who did not consult other doctors before coming to A&E. Their time lags from stroke onset to A&E consultation were compared.
One hundred and fifteen stroke patients were consecutively recruited. Sixty-five ambulance users had median time for phase I as 151 minutes, for phase II as 32 minutes, for phase III as 17 minutes. The total median time lag was 190 minutes. Fifty were ambulance non-users. For those who did not consult other doctors before A&E attendance, the median time lag was 641 minutes. For those who consulted others doctors before A&E attendance, their median time lag was 3,672 minutes. As a group their median time lag was 950 minutes. For the 65 ambulance users, we further studied the time intervals between A&E arrival and being seen by doctors; and the median waiting time for doctors was 17 (range 0 to 60) minutes.
Public education was of paramount importance. Some common stroke signs could be widely propagated for recognition. Phase I should be less than 80 minutes. The median time for phase II would likely remain to be 32 minutes. Further shortening could be achieved in phase III. As category III & IV patients were most likely potential candidates for thrombolysis, they should be seen within 15 minutes. This would leave only 53 minutes for clinical assessment, CT brain and preparation of thrombolytic agent. These measures could increase the chance of providing thrombolytic treatment within the therapeutic time window.
Free accessResearch articleFirst published April, 2003pp. 81-87Implementation of prevention programs for bicycle safety should be based on a good understanding of the profile of bicycle accidents. The objective of this study was to investigate the differences in the severity of bicycle-related injuries when comparing with various risk factors, and to utilize this information to formulate the intervention measures.
A retrospective review was conducted on all patients (n=116) who were treated for bicycle-related injuries within a period of 66 days at the emergency department of a district hospital in Tai Po, New Territories.
School-aged children, especially boys, were more commonly injured. The head and lower extremities were the common sites of injuries. Female gender (χ2=4.39; P<0.05) and injuries involving head and upper extremities (χ2=12.61; P<0.05) were associated with higher chance of serious injury.
Tai Po district had a high incidence of bicycle accidents due to its geographical location. Population at a greater risk for bicycle injury was the male gender school-aged children and therefore prevention program should be targeted at them.
Free accessResearch articleFirst published April, 2003pp. 88-96Injury is the commonest cause of morbidity and mortality amongst the younger age groups. Management of injuries has been identified as one of the major health issues facing our community. The study objective was to define the epidemiology of injury related deaths in Singapore.
A nationwide review of all deaths arising as a result of injury in 1995 was conducted.
There were 913 cases with an injury mortality rate of 27 per 100,000 population. Ninety-seven percent (97%) were due to blunt injury. Falls from heights from deliberate self-harm was the commonest mechanism, followed by motor vehicle collisions (MVC). Fifty-two percent (52%) of MVC deaths were motorcyclists or pillion riders. Sixty-six percent (66%) of all deaths occurred in the prehospital phase. Central nervous system injury was the main cause of hospital deaths.
Results from this study will help our community focus on the appropriate preventive strategies to reduce mortality and the cost of injuries to our society.
Free accessResearch articleFirst published April, 2003pp. 97-103Singapore is an affluent small nation-state with a high per capita gross domestic product.
To determine the prevalence of hunger and poverty among elderly patients attending an emergency department (ED).
All patients aged 65 years and above who sought treatment at the ED of an urban acute care hospital over one week between 0900 and 1700 hours were surveyed. Two trained interviewers administered a face-to-face close-ended questionnaire. Data collected were demographics, health status and surrogate indicators of poverty and hunger.
Of the 210 non-critically ill patients approached, data was available for 194 (92.4%), of which 51% were men. The mean age was 76.7 (SD 7.4) years. Majority of the patients were well taken care of but a minority were not coping: 0.5% was homeless, 3.1% had skipped medical appointments in the last year due to lack of money, 1% did not have enough to eat and were not receiving any food aid and 1.5% borrowed money to buy food in the previous six months. Despite their advanced age, there were 12 (6.2%) who were sole breadwinners for their families. Twenty-one patients (10.8%) were already on welfare assistance and 5.7% received food aid to supplement their basic food needs.
Though the numbers were not alarming, it was worrying that some elderly patients were going hungry or skipping medical appointments due to lack of money or still had family dependent on their income. The ED can help by actively identifying these at-risk elderly and referring them for welfare assistance.
Free accessResearch articleFirst published April, 2003pp. 104-112Few studies on the attitude of nurses toward alcoholic patients have been conducted in Hong Kong. The aim of this study was to understand the attitude of nurses toward alcoholic patients in local Accident and Emergency Departments (AEDs). Alcoholism is a stigmatized ‘disease’. Some studies revealed that nurses tended to have negative attitudes toward people with alcoholic problems. This can influence the quality of healthcare provided to this group of patients. As a result, alcoholic patients may not be properly treated. The researchers of this study employed a cross-sectional survey to gather data from the targeted sample. The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) was used to evaluate the attitudes of nurses toward alcoholic patients. In addition, relationships between therapeutic attitude toward alcoholic patients and various independent variables (including experience in specialty, education related to alcohol and alcoholic problems, the degree of support received from co-workers, and self-esteem of individuals) were analyzed. Six hundred nursing staff, including registered nurses, enrolled nurses and nursing officers working in AED, were invited to participate in the study. One hundred and ninety (31.6%) of them responded. The findings showed that nurses working in AEDs tended to have negative attitudes toward alcoholic patients. Most of those surveyed got low scores in role security, which indicated they perceived themselves inadequate in both skills and knowledge relating to problem drinkers. The findings also reflected that the degree of support received and self-esteem correlated with the overall attitude toward alcoholic patients. To conclude, providing more support and training opportunities to nursing staff are conducive to more positive attitude of nurses toward alcoholic patients.
Free accessResearch articleFirst published April, 2003pp. 113-119Interview skills traditionally receive little emphasis in the medical profession, in contrast to clinical and technical skills. However, good interview skills have a major impact on a doctor's career. Unfortunately, there is hardly any reference in the medical literature on employment interview skills. This is a review of the preparation, expectation, etiquette and presentation for interviews from ‘management sources’ and is equally applicable to the medical profession.
Free accessResearch articleFirst published April, 2003pp. 121-123Acute myocardial infarction (AMI) is one of the most alerting situations in emergency department. Electrocardiogram (ECG) is one of the most important diagnostic tools and the decision about thrombolytic therapy is usually based upon ECG findings when clinically suspicious. However, ST segment elevation is not always equivalent to acute myocardial infarction. We present a rare syndrome whose ECG shows persistent ST elevation not related to AMI.
Free accessResearch articleFirst published April, 2003pp. 124-129Currently law enforcement agencies in 10 countries have been granted approval for the use of police bean bag. The need for “less lethal” weapon to control violent suspects is under hot discussion. The manufacturer acknowledges that this weapon will only cause bruises, skin abrasions and minor injuries so as to incapacitate the violent suspect. The objective of this study was to see the degree of trauma produced by shooting police bean bag at different firing ranges.
Fresh pork was chosen for this test. The pork was subjected to police bean bag challenge at two different firing ranges. A standard shotgun (Model Remington 870P) was used. In order to test the degree of trauma to different parts of the body, regions with small amount of soft tissue (pig rib) and large amount of soft tissue (pig thigh) were selected. Each region would receive challenge of police bean bag at three and five meters range shot. The above test was repeated with heavy clothing covering the pork.
It was shown that all shots of police bean bag could produce injuries, ranging from minor indentation to laceration of soft tissues. The degree of trauma was greatly diminished if the target had been protected by heavy clothing. Moreover, the trauma produced on rib region was more severe than that of the thigh region. The larger volume of soft tissue, the better absorption of kinetic energy was expected and resulted in lesser degree of injuries.
Although police bean bag can still produce injuries, there is great potential for bean bag technology as this is an alternative to deadly force. Both suspects and law enforcement agencies can benefit from this less lethal technology as police bean bag clearly causes fewer fatal injuries and death than traditional bullets.