Application of geographical information system (GIS) and logistic regression analysis to investigate spatial, temporal and clinical risk factors for road traffic injury (RTI) within Kota Bharu district

This was a Prospective Cohort Study commencing from July 2011 until June 2013 involving all injuries related to motor vehicle crashes (MVC) attended Emergency Department (ED), Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab 2 (HRPZ 2) Kota Bharu Kelantan. Selected attributes were geospatially analysed by using ARCGIS (by ESRI) software version 10.1 licensed to the USM and Google Map free software and multiple logistic regression was performed by using SPSS version 22.0. A total of 439 cases were recruited. The mean age (SD) of the MVC victims was 26.04 years (s.d 15.26). Male comprised of 302 (71.7%) of the cases. Motorcyclists were the commonest type of victims involved 351(80.0%). Hotspot MVC locations occurred at certain intersections and on roads within Mukim Kenali and Binjai. The number of severely injured and polytrauma are most on the road network within speed limit of 60 km/hour. A person with an increase in ISS of one score had a 37 % higher odd to have disability at hospital discharge (95% CI: 1.253, 1.499, p-value < 0.001). Pediatric age group (less than 19 years of age) had 52.1% lesser odds to have disability at discharge from hospital (95% CI: 0.258, 0.889, p-value < 0.001) and patients who underwent operation for definitive management had 4.14 times odds to have disability at discharge from hospital (95% CI: 1.681, 10.218, p-value = 0.002). An increase in ISS of one score had a 50 % higher the odds to be admitted to hospital (95% CI: 1.359, 1.650, p-value <0.001). Men and those who received multi-intervention had 3.1 (95% CI: 1.345, 7,138, p-value = 0.008) and 6.1 times odds (95% CI: 3.095, 12.121, p-value < 0.001) respectively to be admitted to hospitals following MVC. This study combined geospatial and traditional statistical analyses to evaluate the relationship between injury-related MVCs and clinical parameters and its outcomes. Overall this study has proven that GIS with a combination of traditional statistical analysis is a powerful tool in RTI related research

Analysis Of Pain Relief In Emergency Room For Acute Pain In Hospital Unlversiti Sains Malaysia

The objective of this study is to assess acute pain management in Accident & Emergency Department Hospital Universiti Sains Malaysia in term of degree of pain relief on leaving the unit

Enhancing road traffic safety: application of geographical information system (gis) analysis to identify spatial & terporal risk factors for severe road traffic injury within Kota Bharu district

Road traffic injuries (RTI) is a very common cause of admission to the hospital worldwide, in particular in the developing countries (Hyder, 2014). It has been a long and agonizing disease that contributes to major cause of loss to life, long term suffering, disablement and psychological sequelae to both the victims & carer. However in particular, in Malaysia it is well known that there is lack of research into RTI epidemiology. The primary aim of this study is to document the demographic parameters, the predominant injury mechanisms and severity, geographical positioning data (i.e coordinates of the incidents locations), spatial data, mortality, length of hospital stay and finally the clinical outcome. The overall output is integrated spatial-temporal, pre-hospital and clinical data. We prospectively & retrospectively identified all injured subjects who had been referred to our department after sustaining RTIs within the district of Kota Bharu. We will also obtain the data from Hospital Raja Perempuan Zainab 2 Kota Bharu (MOH) & the police POL27 (Accident computerized form) form. All patients must be diagnosed with road related injuries. For this study, we extracted age, gender, accident mechanisms and causes, and vehicle types from the police & hospital management and outcome. A set of digital maps will be obtained from the Town Planning Unit of Kota Bharu Municipal Office (local district map). Vector spaces were spanned over these maps using GIS software (ARCGIS 10.1 licensed to USM), and data from the identified trauma cases were added. Spatial analysis and overlay tools were used to identify local clusters of events. The data collected using manual data form will be transferred into the SPSS version 22.0 software produced by IBM and licensed to the USM. The data form comprises of several sections such as general demography, injury data, prehospital care, ED management, outcome and geographical data. The variables will be in both categorical and numerical data. The data will be analyzed by variety of methods ranging from descriptive analysis, univariate analysis and multivariate analysis. A total of 439 cases were recruited over the ten month data collection period commencing August 2012 till May 2013. The data showed that motorcycle contributed most (82%) to the RTI victims. Most of the RTI cases occurred along hotspot areas within certain Mukim/Borough within the Kota Bharu District namely Kenali, Demit and Binjai areas. The factors associated with the duration of stay and disability outcome include injury severity score (ISS) and being operated in the hospital. The most common areas of occurrence of RTI include staright road, at non peak hours, in the evening and in the suburban areas. The RTI cases within the Kota Bharu district follow the genaral pattern of RTI cases in other parts of Malaysia. The identification of general demographic and geographical pattern of the RTI will assist the policy maker in implementing the preventive program for road safety in future. The research involved 2 parts: the GIS analysis for RTI hotspot for the vulnerable road users and th, analysis for associated factors for disability and the prolonged hospital stay after the RTI. Overall o' and half year period of data collection showed that majority of vulnerable road users involved in R1 among the motorcyclists. The pillion and main riders are equally involved in the RTI. Most of the ir involved the average age of 44 years and among the productive working group. The helmet wearing among the common geographical features where the RTI occurred are straight road, within suburbai area with speed limit of 60km/hr. The buffer analysis within 100 meters of the acccident showed th< common build up surrounding involved include the shop lots, restaurants/cafe and villages. The geo parameters and the clinical parameters were combined and the multiple logistic regression analysis performed searching for the association factors for the disabhty and prolonged hospital stay outcom analysis showed that the injury severity score is the main predictive factors for both outcome. None geographical factors are strong enough to predict the two outcomes

The use of end-tidal capnography to monitor non-intubated patients presenting with acute exacerbation of asthma in the emergency department.

STUDY OBJECTIVE To determine if the slope of Phase II and Phase III, and the alpha angle of the expiratory capnographic waveform, as measured via computer-recognizable algorithms, can reflect changes in bronchospasm in acute asthmatic non-intubated patients presenting to the emergency department (ED). METHODS In this prospective study carried out in a university hospital ED, 30 patients with acute asthma were monitored with clinical severity scoring and peak flow measurements, and then had a nasal cannula attached for sidestream sampling of expired carbon dioxide. The capnographic waveform was recorded onto a personal computer card for analysis. The patients were treated according to departmental protocols. After treatment, when they had improved enough for discharge, a second set of results was obtained for capnographic waveform recording. The pre-treatment and post-treatment results were then compared with paired-samples t-test analysis. RESULTS On the capnographic waveform pre- and post-treatment, there was a significant difference in the slope of Phase III (p < 0.001) and alpha angle (p < 0.001), but not in the Phase II slope (p = 0.35). There was significant change in peak flow meter reading, but it was poorly correlated with all the capnographic indices. CONCLUSION The study provides some preliminary data showing that capnographic waveform indices can indicate improvement in airway diameter in acute asthmatics in the ED. Capnographic waveform analysis presents several advantages in that it is effort-independent, and provides continuous monitoring of normal tidal respiration. With further refined studies, it may serve as a new method of monitoring non-intubated asthmatics in the ED

Emergency medical services key performance measurement in Asian cities

10.1186/s12245-015-0062-7International Journal of Emergency Medicine8

A five-year retrospective review of snakebite patients admitted to a tertiary university hospital in Malaysia

BACKGROUND Although the majority of the snakebite cases in Malaysia are due to non-venomous snakes, venomous bites cause significant morbidity and mortality if treatment measures, especially ant-venom therapy, are delayed. METHODS To determine the demographic characteristics, we conducted a retrospective study on all snakebite patients admitted to the Emergency Department of Hospital Universiti Sains Malaysia (HUSM) from January 2006 to December 2010. RESULTS In the majority of the 260 cases that we found (138 cases or 52.9%), the snake species was unidentified. The most common venomous snakebites among the identified species were caused by cobras (52 cases or 20%). Cobra bites are significantly more likely to result in severe envenomation compared to non-cobra bites. Post hoc analysis also showed that cobra bite patients are significantly less likely to have complete recovery than non-cobra bite patients (48 cases, 75.0% vs. 53 cases, 94.6%; p = 0.003) and more likely to result in local gangrene (11 cases, 17.2% vs. 3 cases, 5.4%; p = 0.044). CONCLUSION Cobra bites are significantly more likely to result in severe envenomation needing anti-venom administration and more likely to result in local gangrene, and the patients are significantly less likely to have complete recovery than those with non-cobra bites

A multicenter controlled trial on knowledge and attitude about cardiopulmonary resuscitation among secondary school children in Malaysia.

BACKGROUND We performed a multicenter controlled trial to assess the knowledge and attitude (KA) about cardiopulmonary resuscitation (CPR) among secondary school children in a district in Malaysia. METHODS This was a prospective intervention study. The primary endpoint of the study was to determine the level of KA about resuscitation after CPR training. The six schools and classes from selected schools were chosen by randomization among the form three and four classes using sealed envelopes. A fully validated questionnaire consisting of three sections (sociodemographic, knowledge and attitude) was given to the pupils before and 2 weeks after the intervention. The intervention group was given a lecture, video show, pamphlet and 1-h practical session on CPR training. The control group received a placebo in order to overcome the learning effect. The maximum scores for the knowledge and attitude sections were 72 and 28, respectively. Repeated measures ANOVA analysis was used for specific objectives to determine the changes in knowledge and attitude level pre- and post-intervention for both study groups. P-values less than 0.05 were taken as significant at 95% confidence intervals. RESULTS The mean (SD) total knowledge scores for the intervention (n = 216) and control (n = 252) groups were 62.43 (13.68) and 62.29 (12.11), respectively (maximum score 72) (p > 0.05). On the other hand, the mean (SD) total attitude scores for the intervention and the control groups were 19.33 (4.51) and 17.85 (4.52), respectively (maximum score 28) (p < 0.001). There were significant differences in mean knowledge and attitude scores between the intervention and control groups with regard to time (pre- and post-intervention). The mean difference in knowledge and attitude scores between both study groups was 8.31 (p < 0.001) and 2.39 (p < 0.001), respectively. CONCLUSIONS The level of knowledge and attitudes of secondary school children was shown to be acceptable prior to the intervention. Furthermore, a brief CPR training program improved their level of knowledge and attitudes significantly as compared to those who had never been trained

Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services

Clinical evaluation of i-step qualitative heart-specific fatty acid binding protein (h-fabp) test (cardiodetect®) and quantitative cardiac troponin t, for the diagnosis of acute myocardial infarction in the emergency department

Objective To assess the diagnostic indices of the CardioDetect assay and the quantitative cardiac troponin T test, in diagnosing AMI in the ED, according to the time of onset of chest pain. Methodology A total of eighty eligible patients presenting with ischemic type chest pain with duration of symptoms within the last 36 hours were enrolled. All patients were tested for H-FABP and Troponin T at presentation to ED. A repeated Cardiodetect test was performed one hour after the initial negative result, and a repeated Troponin T test was also performed 8- 12 hours after an initial negative result. The diagnostic indices [sensitivity, specificity, positive predictive value, negative predictive value, receiver operating curve (ROC)] were analysed for CardioDetect and Troponin T (individually and in combination), and also for the repeat CardioDetect test. Data entry and analysis was performed using SPSS version 12.0 and analyse-it software. Results The CardioDetect test was more sensitive and had a higher NPV than troponin T (TnT) test during the first 12 hours of onset of chest pain. The repeat CardioDetect had better sensitivity and NPV than the initial CardioDetect. The sensitivity and NPV of the combination test (CardioDetect and troponin T) was also superior to the each test performed individually. Conclusion CardioDetect test is more sensitive and has a better NPV than Troponin T during the first 12 hours of AMI. It may be used to rule out myocardial infarction during the early phase of ischemic chest pain