Displaying publications 21 - 40 of 266 in total

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  1. Azhar AA, Ismail MS, Ham FL
    Med J Malaysia, 2000 Jun;55(2):164-8.
    PMID: 19839143
    A total of 37,152 patients attended the Accident & Emergency (A&E) Department of Hospital Universiti Kebangsaan Malaysia (HUKM) from 1st January to 31st December 1998. Attendance during early hours (midnight to 0659 hrs.) constituted only 10.4% (3853 cases) whereas that for three other time periods of 0700-1159 hrs., 1200-1759 hrs., and 1800-2359 hrs. was 29.4% (10,927 cases), 30.8% (11,448 cases), and 29.4% (10,924 cases) respectively. Two hundred and fifty-one patients were direct admissions from other hospitals into our hospital wards and they attended the A&E department for registration purposes only. Of the remaining 36,901 that were triaged, 196 (0.5%) were resuscitation cases [Triage 1], 3648 (9.9%) were emergency cases [Triage 21, 18,935 (51.3%) were urgent cases [Triage 3], and 14,122 (38.3%) were non-urgent cases [Triage 4]. Despite fluctuations in monthly patient attendance, the proportions of patients according to time of attendance, age group, gender and triage categories remained similar throughout. As majority of patients attended during convenient hours (89.6% from 0700-2359 hrs.) and a high proportion of patients (38.3%) belonged to the non-urgent Triage category, we feel that public emergency services are possibly being abused.
    Matched MeSH terms: Emergency Service, Hospital/utilization*
  2. Nivedita N
    Med J Malaysia, 1996 Mar;51(1):89-92.
    PMID: 10967985
    A study was undertaken to determine the assessment and management of adult asthmatic patients presenting to the Accident and Emergency department. The records of 50 consecutive adult asthmatic patients presenting to A & E with acute bronchial asthma between June 1993 to April 1994 were reviewed. Patients were also interviewed on their subsequent visit to hospital. Observations and measurements used to assess the severity of asthma were recorded with variable frequency--cyanosis 8%, inability to speak 2%, chest auscultation 64%, heart rate 10%, blood pressure 6%, respiratory rate 4%. The failure to record more objective measurements of severity of asthma and in particular extent of airflow obstruction is cause for concern. The drugs used to treat acute asthma in order of frequency were Beta agonists by nebuliser, 49 patients; intravenous aminophylline, 8 patients; and intravenous corticosteroids, 6 patients. 15 patients were admitted to the medical ward. The decision to admit patients appeared to be due to a lack of symptomatic improvement after treatment. Of the 35 patients who were discharged from A & E, 13 (37%) had an acute relapse within 10 days. None of the patients on discharge from A & E were given a short course of oral steroids or were advised an increase in steroid inhaler therapy. There was therefore a gross underuse of corticosteroids.
    Study site: Emergency department, Hospital Muar, Johor, Malaysia
    Matched MeSH terms: Emergency Service, Hospital*
  3. Jatau AI, Aung MMT, Kamauzaman THT, Ab Rahman AF
    Complement Ther Clin Pract, 2018 May;31:53-56.
    PMID: 29705480 DOI: 10.1016/j.ctcp.2018.01.016
    OBJECTIVE: Traditional and Complementary Medicines (TCM) are widely used worldwide, and many of them have the potential to cause toxicity, interaction with conventional medications and non-adherence to prescribed medications due to patients' preference for the TCM use. However, information regarding their use among patients seeking care at emergency departments (ED) of a healthcare facility is limited. The study aimed to evaluate the TCM use among patients attending the ED of a teaching hospital in Malaysia.

    STUDY DESIGN: A sub-analysis of data from a prevalence study of medication-related visits among patients at the ED of Hospital Universiti Sains Malaysia was conducted. The study took place over a period of six weeks from December 2014 to January 2015 involving 434 eligible patients. Data on demography, conventional medication, and TCM uses were collected from patient interview and the medical folders.

    RESULTS: Among this cohort, 66 patients (15.2%, 95%CI 12.0, 19.0) reported concurrent TCM use. Sixteen (24.2%) of the TCM users were using more than one (1) type of TCM, and 17 (25.8%) came to the ED for medication-related reasons. Traditional Malay Medicine (TMM) was the most frequently used TCM by the patients. Five patients (7.6%) sought treatment at the ED for medical problems related to use of TCM.

    CONCLUSION: Patients seeking medical care at the ED may be currently using TCM. ED-physicians should be aware of these therapies and should always ask patients about the TCM use.

    Matched MeSH terms: Emergency Service, Hospital/statistics & numerical data*
  4. Chang SH, Hsieh CH, Weng YM, Hsieh MS, Goh ZNL, Chen HY, et al.
    Biomed Res Int, 2018;2018:6983568.
    PMID: 30327779 DOI: 10.1155/2018/6983568
    Background: Renal abscess is a relatively uncommon yet debilitating and potentially fatal disease. There is no clearly defined, objective risk stratification tool available for emergency physicians' and surgeons' use in the emergency department (ED) to quickly determine the appropriate management strategy for these patients, despite early intervention having a beneficial impact on survival outcomes.

    Objective: This case control study evaluates the performance of Mortality in Emergency Department Sepsis Score (MEDS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting risk of mortality in ED adult patients with renal abscess. This will help emergency physicians, surgeons, and intensivists expedite the time-sensitive decision-making process.

    Methods: Data from 152 adult patients admitted to the EDs of two training and research hospitals who had undergone a contrast-enhanced computed tomography scan of the abdomen and was diagnosed with renal abscess from January 2011 to December 2015 were analyzed, with the corresponding MEDS, MEWS, REMS, RAPS, and mortality risks calculated. Ability to predict patient mortality was assessed via receiver operating curve analysis and calibration analysis.

    Results: MEDS was found to be the best performing physiologic scoring system, with sensitivity, specificity, and accuracy of 87.50%, 88.89%, and 88.82%, respectively. Area under receiver operating characteristic curve (AUROC) value was 0.9440, and negative predictive value was 99.22% with a cutoff of 9 points.

    Conclusion: Our study is the largest of its kind in examining ED patients with renal abscess. MEDS has been demonstrated to be superior to MEWS, REMS, and RAPS in predicting mortality for this patient population. We recommend its use for evaluation of disease severity and risk stratification in these patients, to expedite identification of critically ill patients requiring urgent intervention.

    Matched MeSH terms: Emergency Service, Hospital*
  5. Mohammed KI, Zaidan AA, Zaidan BB, Albahri OS, Albahri AS, Alsalem MA, et al.
    Comput Methods Programs Biomed, 2020 Mar;185:105151.
    PMID: 31710981 DOI: 10.1016/j.cmpb.2019.105151
    CONTEXT: Telemedicine has been increasingly used in healthcare to provide services to patients remotely. However, prioritising patients with multiple chronic diseases (MCDs) in telemedicine environment is challenging because it includes decision-making (DM) with regard to the emergency degree of each chronic disease for every patient.

    OBJECTIVE: This paper proposes a novel technique for reorganisation of opinion order to interval levels (TROOIL) to prioritise the patients with MCDs in real-time remote health-monitoring system.

    METHODS: The proposed TROOIL technique comprises six steps for prioritisation of patients with MCDs: (1) conversion of actual data into intervals; (2) rule generation; (3) rule ordering; (4) expert rule validation; (5) data reorganisation; and (6) criteria weighting and ranking alternatives within each rule. The secondary dataset of 500 patients from the most relevant study in a remote prioritisation area was adopted. The dataset contains three diseases, namely, chronic heart disease, high blood pressure (BP) and low BP.

    RESULTS: The proposed TROOIL is an effective technique for prioritising patients with MCDs. In the objective validation, remarkable differences were recognised among the groups' scores, indicating identical ranking results. In the evaluation of issues within all scenarios, the proposed framework has an advantage of 22.95% over the benchmark framework.

    DISCUSSION: Patients with the most severe MCD were treated first on the basis of their highest priority levels. The treatment for patients with less severe cases was delayed more than that for other patients.

    CONCLUSIONS: The proposed TROOIL technique can deal with multiple DM problems in prioritisation of patients with MCDs.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  6. Chelladurai G, Noor Azhar AM, Mohd Isa R, Bustam A, Ahmad R, Munisamy M
    Med J Malaysia, 2020 09;75(5):514-518.
    PMID: 32918419
    INTRODUCTION: Cardiopulmonary Resuscitation (CPR) remains the primary mechanism of resuscitation for cardiac arrest victims. However, the quality of delivery of CPR varies widely in different settings, possibly affecting patient outcomes. This study is aimed to determine the efficacy of an audio-visual (AV) CPR feedback device in improving the quality of CPR delivered by healthcare providers.

    METHODS: This pre-post, single-arm, quasi-experimental study randomly sampled 140 healthcare providers working in the Emergency Department of Hospital Ampang, Malaysia. Parameters of CPR quality, namely chest compression rate and depth were compared among participants when they performed CPR with and without an AV CPR feedback device. The efficacy of the AV CPR feedback device was assessed using the Chi-square test and Generalised Estimating Equations (GEE) models.

    RESULTS: The use of an AV CPR feedback device increased the proportion of healthcare providers achieving recommended depth of chest compressions from 38.6% (95% Confidence Interval, 95%CI: 30.5, 47.2) to 85.0% (95%CI: 78.0, 90.5). A similar significant improvement from 39.3% (95%CI: 31.1, 47.9) to 86.4% (95%CI: 79.6, 91.6) in the recommended rate of chest compressions was also observed. Use of the AV CPR device significantly increased the likelihood of a CPR provider achieving recommended depth of chest compressions (Odds Ratio, OR=13.01; 95%CI: 7.12, 24.01) and rate of chest compressions (OR=13.00; 95%CI: 7.21, 23.44).

    CONCLUSION: The use of an AV CPR feedback device significantly improved the delivered rate and depth of chest compressions closer to American Heart Association (AHA) recommendations. Usage of such devices within real-life settings may help in improving the quality of CPR for patients receiving CPR.

    Matched MeSH terms: Emergency Service, Hospital*
  7. Rahman NH, Ananthanosamy C
    Int J Emerg Med, 2014;7:36.
    PMID: 25635196 DOI: 10.1186/s12245-014-0036-1
    BACKGROUND: Acute pain assessment in the emergency department (ED) is important in particular during the triage process. Early pain assessment and management improve outcome. The objective of this study was to determine the effects of documentation and display of patient's self-assessment of pain using numerical rating scale (NRS) on analgesic use among adult trauma patients in ED.
    METHODS: A randomized control trial was conducted recruiting 216 trauma patients who presented to ED of two tertiary centers. Pain score was done using NRS for all patients. They were randomized into pain score display group or not displayed in the control. The outcome measured were proportion of patients receiving analgesics and timing from triage to analgesic administration.
    RESULTS: The proportion of patients who received analgesics when pain score was displayed was 6.5% more than when pain score was not displayed. This difference was however not statistically significant. However, stratified categorical analysis using chi-square showed that the displayed severe pain group was 1.3 times more likely to receive analgesics compared to the non-displayed group. The mean timing to analgesic administration for the displayed and non-displayed groups were 81.3 ± 41.2 (95% C.I 65.9, 96.7) and 88.7 ± 45.4 (95% C.I 69.0, 108.3), respectively (p > 0.05).
    CONCLUSIONS: The proportion of patients who received analgesics increased when NRS was displayed. However, the pain display has no significant effect on the timing of analgesics.
    KEYWORDS: Acute pain; Analgesic; Pain score; Triage
    Matched MeSH terms: Emergency Service, Hospital
  8. Mohd Mokhtar MA, Pin TM, Zakaria MI, Hairi NN, Kamaruzzaman SB, Vyrn CA, et al.
    Geriatr Gerontol Int, 2015 Aug;15(8):944-50.
    PMID: 25311907 DOI: 10.1111/ggi.12369
    AIM: To determine the pattern of utilization of emergency department (ED) services by older patients in Kuala Lumpur, Malaysia, compared with younger patients in the same setting.
    METHODS: The sociodemographics, clinical characteristics and resource utilization of consecutive patients attending the adult ED at the University Malaya Medical Center were recorded during a typical week.
    RESULTS: A total of 1649 patients were included in the study; 422/1649 (25.6%) were aged ≥60 years and 1077 (74.4%) were aged <60 years. Older adult patients were more likely to be diagnosed with ischemic heart disease (12.6% vs 2.5%, P 
    Matched MeSH terms: Emergency Service, Hospital
  9. Low DW, Looi I, Manocha AB, Ang HA, Nagalingam M, Ayop NA, et al.
    Med J Malaysia, 2012 Oct;67(5):538-9.
    PMID: 23770879 MyJurnal
    A report of a patient with Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation) following cardiac arrest (myocardium ischemia) is presented. A 65 year patient was found unconscious at home. He taken to the emergency department On arrival he was unconscious, his pupils fixed and dilated bilaterally. Resuscitation proceeded for 55 minutes. He was then pronounced dead. Forty minutes later spontaneous breathing was noted and his blood pressure was 110/48 and heart rate 90bpm. He survived a further 13 days in the coronary care unit. The implications for management of cardiac arrest in the emergency and medical department are discussed.
    Matched MeSH terms: Emergency Service, Hospital
  10. Kheng CP, Rahman NH
    Int J Emerg Med, 2012;5(1):31.
    PMID: 22828152 DOI: 10.1186/1865-1380-5-31
    BACKGROUND: The aim of this study was to determine the usefulness of end tidal carbon dioxide (ETCO2) monitoring in hypotensive shock patients presenting to the ED.
    METHODS: This was a prospective observational study in a tertiary ED. One hundred three adults in shock with hypotension presenting to the ED were recruited into the study. They were grouped according to different types of shock, hypovolemic, cardiogenic, septic and others. Vital signs and ETCO2 were measured on presentation and at 30-min intervals up to 120 min. Blood gases and serum lactate levels were obtained on arrival. All patients were managed according to standard protocols and treatment regimes. Patient survival up to hospital admission and at 30 days was recorded.
    RESULTS: Mean ETCO2 for all patients on arrival was 29.07 ± 9.96 mmHg. Average ETCO2 for patients in hypovolemic, cardiogenic and septic shock was 29.64 ± 11.49, 28.60 ± 9.87 and 27.81 ± 7.39 mmHg, respectively. ETCO2 on arrival was positively correlated with systolic and diastolic BP, MAP, bicarbonate, base excess and lactate when analyzed in all shock patients. Early ETCO2 measurements were found to be significantly lower in patients who did not survive to hospital admission (p = 0.005). All patients who had ETCO2 ≤ 12mmHg died in the ED. However, normal ETCO2 does not ensure patient survival.
    CONCLUSION: The use of ETCO2 in the ED has great potential to be used as a method of non-invasive monitoring of patients in shock.
    Study site: Emergency department, Hospital Universiti Sains Malaysia
    Matched MeSH terms: Emergency Service, Hospital
  11. Azeez D, Gan KB, Mohd Ali MA, Ismail MS
    Technol Health Care, 2015;23(4):419-28.
    PMID: 25791174 DOI: 10.3233/THC-150907
    BACKGROUND: Triage of patients in the emergency department is a complex task based on several uncertainties and ambiguous information. Triage must be implemented within two to five minutes to avoid potential fatality and increased waiting time.
    OBJECTIVE: An intelligent triage system has been proposed for use in a triage environment to reduce human error.
    METHODS: This system was developed based on the objective primary triage scale (OPTS) that is currently used in the Universiti Kebangsaan Malaysia Medical Center. Both primary and secondary triage models are required to develop this system. The primary triage model has been reported previously; this work focused on secondary triage modelling using an ensemble random forest technique. The randomized resampling method was proposed to balance the data unbalance prior to model development.
    RESULTS: The results showed that the 300% resampling gave a low out-of-bag error of 0.02 compared to 0.37 without pre-processing. This model has a sensitivity and specificity of 0.98 and 0.89, respectively, for the unseen data.
    CONCLUSION: With this combination, the random forest reduces the variance, and the randomized resembling reduces the bias, leading to the reduced out-of-bag error.
    KEYWORDS: Decision support system; emergency department; random forest; randomized resampling
    Matched MeSH terms: Emergency Service, Hospital
  12. Tan, T.L., Dazlin Masdiana, S., Robertson, C.
    Medicine & Health, 2015;10(1):80-85.
    MyJurnal
    Cardiac concussion is a sudden, direct blunt trauma cause to the chest which led to death. However, there are patients who did not completely fulfil this definition. We report two cases which did not fit into the definition domain. Two male patients presented to Emergency Department with moderate anterior chest pain after motor vehicle crash showed transient anterior ST segment elevation at chest lead V2 and V3 with raised creatine kinase and normal troponin T. The electrocardiogram changes fully resolved after 24 hours. Both patients were discharged uneventfully after 24 hours monitoring in Emergency Department short-stay ward. Conventional definition of cardiac concussion (commotion cordis) and cardiac contusion may be unsuitable to describe these cases. Therefore, we propose the diagnosis of focal
    cardiac concussion. We also highlighted the ability of Emergency Department to manage these patients in short-stay ward.
    Keywords: commotio cordis, chest pain, nonpenetrating, electrocardiography
    Matched MeSH terms: Emergency Service, Hospital
  13. Mohd Said N, Sukonthasarn A, Wangsrikhun S, Chanpransit C
    MyJurnal
    Introduction: The notion of competency in pre-hospital emergency medical service (EMS) personnel is mainly focused on the professional proficiency that he/she has to provide intervention outside of hospital setting. Consequently, the effectiveness of pre-hospital EMS performance very much depends upon the capability of the personnel at the scene and as well during transport to the definitive care center. The aim of this study is to appraise and explore the competency of pre-hospital care staff and provide strategies for improvement.

    Methods: A mixed method approach combining the qualitative and quantitative study design. Of 134 staffs only 111(82.84%) returned the questionnaire. Nine semi-structured interviews and two focus group discussions were performed. The main informants were nurses/assistant medical officers, nurse/assistant medical officer administrators, and emergency physicians.

    Results: From the quantitative finding on the competency of staff handling pre-hospital EMS, all had the essential knowledge and skills. However, most of them reported not having good knowledge and skills for invasive procedures (31%-61%), include giving medications (61%-66%). The qualitative information provided insight about the issues and strategies for the personnel in regards to competency. All the relevant qualitative data were merged into 5 categories relating issues and 5 categories to strategies that could affect the competency of the personnel.

    Conclusion: Pre-hospital EMS systems need to consider that the competency of pre-hospital EMS personnel has to come along with the responsible attitude of the staff itself, the support of medical direction, clear protocol for guiding them whenever needed, and continuous professional-development courses require them to maintain their professional proficiency.
    Matched MeSH terms: Emergency Service, Hospital
  14. Nik Azlan, N.M., Ismail, M.S.
    Medicine & Health, 2013;8(1):0-0.
    MyJurnal
    Emergency Department Overcrowding (EDOC) has been a longstanding problem. It is defined as a situation where the demand for emergency services exceeds the ability of an Emergency Department (ED) to provide quality care within appropriate time frames. Hospital beds closure or access block to ward admission is one of the most important cause of Emergency s e.g. disaster. A surge response entails even greater responses including implementing Department overcrowding. This could be compounded further in events of a patient surge eg affirmative measurement in order to mitigate the issue in tackling the situation. The steps in managing EDOC were: 1. Recognizing EDOC, 2. Initiating action, 3. Maintaining patient flow, 4. Setting clinical goals and 5. Deploying a Surge Team for Advance Triage or Fast Tract.
    Matched MeSH terms: Emergency Service, Hospital
  15. Anuar Deen, M.K., Mohd Fairuz, A., Zuraidah, C.M., Nik Azlan, N.M.
    Medicine & Health, 2014;9(1):33-43.
    MyJurnal
    This study assessed the level of public awareness pertaining to risk factors, symptoms, treatment and source of information in relation to stroke and transient schaemic attack. Stroke risk profile of the respondents was correlated with their level of knowledge. Using a validated pre-tested questionnaire, 112 respondents were recruited during two separate community events. Respondents completed the questionnaire and underwent health screening. The data were analysed using SPSS version 20. Overall knowledge was poor. Only 35% of the respondents had satisfactory knowledge of the warning signs (p= 0.94) and 29% had satisfactory knowledge on the risk factors (p=0.46). When analysed according to risk groups, 26%, 30% and 41% of respondents had satisfactory awareness in the low, intermediate and high risk group, respectively. None of the respondents knew about the availability of treatment of acute stroke in the emergency department or the importance of rehabilitation as part of stroke management. Public awareness on stroke risk factors, symptoms and management is poor.
    Matched MeSH terms: Emergency Service, Hospital
  16. Nik Muhamad NA, Kwong LJ
    Medicine & Health, 2016;11(1):22-28.
    MyJurnal
    The objectives were to identify factors associated with early revisit of adult patients with acute asthma exarcebation discharged from the Emergency Department (ED). It was a retrospective cohort study with patients aged 12 years or more within a period of 1 month and who were treated for acute asthma and discharged from the ED of Sarawak General Hospital. A total of 397 patients fulfilled sampling criteria and out of this number, 13.9% had revisit to the ED within 2 weeks. In all of these revisit cases, 9.1% were actually admitted. Prescription rate of oral corticosteroid was found to be low (24.9%) and abscond rate was high (25.1%). Patients who absconded from the ED and their concurrent infection were associated with early ED revisit.
    Matched MeSH terms: Emergency Service, Hospital
  17. Saifful, N. I., Afliza, A. B., Tan, T. L.
    Medicine & Health, 2017;12(2):348-351.
    MyJurnal
    Open tracheal injury is rare but can lead to disastrous consequences such as massive bleeding, airway obstruction or failure and aspiration of blood. We present a case of open tracheal injury of a man who tried to attempt suicide using a knife. In this case, the initial management was securing the airway by attempting orotracheal intubation. However, it was unsuccessful when the tube came out from the laceration wound. Intubation was then re-attempted through the distal cut-end of the trachea in the face of airway failure. A quick initial assessment and anticipation of a failed airway should always be the top priority in any emergency physician managing these cases. Direct intubation through the laceration wound might be the only option when all else fail and your patient is crashing.
    Keywords: intubation, laceration, trachea
    Matched MeSH terms: Emergency Service, Hospital
  18. Narwani Hussin, Yvonne Ai Lian Lim, Pik Pin Goh, Timothy William, Jenarun Jelip, Rose Nani Mudin
    MyJurnal
    Introduction: Most of the recent publications on malaria in Malaysia were conducted in Sabah focusing on the emer-gence of Plasmodium knowlesi. This analysis aims to look into the incidence, mortality, and case fatality rate (CFR) of malaria caused by all Plasmodium species in the whole of Malaysia and to compare the different malaria char-acteristics and trends between Peninsular Malaysia (PM) and Sabah & Sarawak. Methods: This is a secondary data review of all malaria confirmed cases notified to the Ministry of Health, Malaysia from January 2013 to December 2017. Results: From 2013 to 2017, a total of 16,500 malaria cases were notified in Malaysia. The cases were mainly contributed from Sabah (7,150; 43.3%) and Sarawak (5,684; 34.4%). Plasmodium knowlesi was the commonest species in Sabah and Sarawak (9,902; 77.1%), while there were more Plasmodium vivax cases (1,548; 42.2%) in PM. The overall average incidence rates (IR), mortality rate (MR) and CFR for malaria in Malaysia were 0.106/1,000, 0.030/100,000 and 0.27%, respectively. Sarawak reported the highest average IR of 0.420/1,000 followed by Sabah (0.383/1,000). Other states in PM reported below the national average IR with
    Matched MeSH terms: Emergency Service, Hospital
  19. Francis Paul, Kent Kong Kian Keong, Jennifer Tan, Anna Lee En Moi, Alen Lim Chung Chieh
    MyJurnal
    Introduction: Maternal death is a sensitive health indicator being monitored closely by the Ministry of Health. Obstetric emergency (OE) protocol is introduced to manage OE and to improve maternal outcome. However, there is no national OE guideline available and the OE protocol varies among different institutions. The current audit aims to evaluate the service quality during OE in Duchess of Kent Hospital (DOKH) in accordance with OE protocol DOKH revision-2017.
    Matched MeSH terms: Emergency Service, Hospital
  20. Hung SK, Kou HW, Hsu KH, Wu CT, Lee CW, Leonard Goh ZN, et al.
    J Formos Med Assoc, 2021 Mar;120(3):997-1004.
    PMID: 32917483 DOI: 10.1016/j.jfma.2020.08.039
    BACKGROUND/PURPOSE: Splenic abscess is a life-threatening surgical emergency which requires early diagnosis and intervention to maximize patient outcomes. This can be achieved through accurate risk stratification in the emergency department (ED). Sarcopenia refers to an age-related loss of skeletal muscle mass and strength that is accompanied by major physiologic and clinical ramifications, and often signifies decreased physiologic reserves. It is associated with poor clinical outcomes in sepsis, acute respiratory failure, oncological surgery, and liver transplantation. This study evaluates the utility of sarcopenia as a radiological stratification tool to predict in-hospital mortality of splenic abscess patients in the ED. This will assist emergency physicians, internists and surgeons in rapid risk stratification, assessing treatment options, and communicating with family members.

    METHODS: 99 adult patients at four training and research hospitals who had undergone an abdominal contrast computed tomography scan in the ED with the final diagnosis of splenic abscess from January 2004 to November 2017 were recruited. Evaluation for sarcopenia was performed via calculating the psoas cross-sectional area at the level of the third lumbar vertebra and normalising for height, before checking it against pre-defined values. Univariate analyses were used to evaluate the differences between survivors and non-survivors. Sensitivity, specificity, and predictive values of the presence of sarcopenia in predicting in-hospital mortality were calculated. Kaplan-Meier methods, log-rank test, and Cox proportional hazards model were also performed to examine survival between groups with sarcopenia versus non-sarcopenia.

    RESULTS: Splenic abscess patients with sarcopenia were 7.56 times more at risk of in-hospital mortality than those without sarcopenia (multivariate-adjusted HR: 7.56; 95% CI: 1.55-36.93). Presence of sarcopenia was found to have 84.62% sensitivity and 96.49% negative predictive value in predicting mortality.

    CONCLUSION: Sarcopenia is associated with poor prognoses of in-hospital mortality in patients with splenic abscess presenting to the ED. We recommend its use in the ED to rapidly risk stratify and predict outcome to guide treatment strategies.

    Matched MeSH terms: Emergency Service, Hospital
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