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  1. Fulltext Knowledge of Good Blood Culture Sampling Practice among Healthcare Staffs in An Emergency Department - Are We Getting It Right?
    Chew KS, Mohd Hashairi F, Jusoh AF, Aziz AA, Nik Hisamuddin NAR, Siti Asma H
    Med. J. Malaysia, 2013 Aug;68(4):323-5.
    PMID: 24145260 MyJurnal
    Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice.
    Matched MeSH terms: Emergency Service, Hospital*
  2. Fulltext The pattern of death related to trauma cases presented to the emergency department of a tertiary university hospital
    Nik Ab Rahman NH, Mohd Hussain H
    Med. J. Malaysia, 2013 Apr;68(2):148-52.
    PMID: 23629562 MyJurnal
    Trauma is an ever increasing problem and it is the leading cause of morbidity and mortality in the under 40s age group. The main purpose of this study is to determine the pattern of death related to trauma cases presenting to the emergency department (ED) of a university hospital. This was a retrospective analysis of 75 consecutive trauma case records at a university hospital for a one year period. The most common cause of deaths is motor vehicle crashes. The mean score for the injury severity score (ISS) and revised trauma score (RTS) on arrival to the ED among the succumbed patients were 27.8 (s.d 8.6) and 5.7 (s.d 1.1) respectively. 58.7% of deaths occurred within 48 hours after the admission. Less than 50% of studied patients were still alive beyond 45 hours post admission and less than 10% still alive beyond 11 days. Our analysis also showed that 28% (n=21) and 56% (n=41) of the studied sample had a probability of survival between 50% to 75% and more than 75% respectively upon arrival based on the initial vital signs in the ED and the trauma and injury severity score (TRISS) methodology. Overall, we observed similar injury mechanisms, demographics and causes of death compare to other studies. The figures from this study, mandate further exploration of preventive issues and management improvements that should be applied not only to the current trauma system, but also to the health care system in general.
    Matched MeSH terms: Emergency Service, Hospital*
  3. Potential problems with interventions that restrict access to patients who present inappropriately to Emergency Departments
    Ting JY
    Med. J. Malaysia, 2005 Aug;60(3):392-3.
    PMID: 16379203
    Matched MeSH terms: Emergency Service, Hospital/utilization*
  4. Fulltext Comparison of adaptive neuro-fuzzy inference system and artificial neutral networks model to categorize patients in the emergency department
    Azeez D, Ali MA, Gan KB, Saiboon I
    Springerplus, 2013;2:416.
    PMID: 24052927 DOI: 10.1186/2193-1801-2-416
    Unexpected disease outbreaks and disasters are becoming primary issues facing our world. The first points of contact either at the disaster scenes or emergency department exposed the frontline workers and medical physicians to the risk of infections. Therefore, there is a persuasive demand for the integration and exploitation of heterogeneous biomedical information to improve clinical practice, medical research and point of care. In this paper, a primary triage model was designed using two different methods: an adaptive neuro-fuzzy inference system (ANFIS) and artificial neural network (ANN).When the patient is presented at the triage counter, the system will capture their vital signs and chief complains beside physiology stat and general appearance of the patient. This data will be managed and analyzed in the data server and the patient's emergency status will be reported immediately. The proposed method will help to reduce the queue time at the triage counter and the emergency physician's burden especially duringdisease outbreak and serious disaster. The models have been built with 2223 data set extracted from the Emergency Department of the Universiti Kebangsaan Malaysia Medical Centre to predict the primary triage category. Multilayer feed forward with one hidden layer having 12 neurons has been used for the ANN architecture. Fuzzy subtractive clustering has been used to find the fuzzy rules for the ANFIS model. The results showed that the RMSE, %RME and the accuracy which evaluated by measuring specificity and sensitivity for binary classificationof the training data were 0.14, 5.7 and 99 respectively for the ANN model and 0.85, 32.00 and 96.00 respectively for the ANFIS model. As for unseen data the root mean square error, percentage the root mean square error and the accuracy for ANN is 0.18, 7.16 and 96.7 respectively, 1.30, 49.84 and 94 respectively for ANFIS model. The ANN model was performed better for both training and unseen data than ANFIS model in term of generalization. It was therefore chosen as the technique to develop the primary triage prediction model. This primary triage model will be combined with the secondary triage prediction model to produce the final triage category as a tool to assist the medical officer in the emergency department.
    Matched MeSH terms: Emergency Service, Hospital
  5. Fulltext Factors associated with discharge against medical advice from emergency department, Universiti Kebangsaan Malaysia Medical Centre
    Ismail, A.K., Mohamad Ali, S., Che' Man, Z.
    Medicine & Health, 2016;11(1):29-37.
    MyJurnal
    Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09-15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.
    Matched MeSH terms: Emergency Service, Hospital
  6. A perspective on emergency medicine in the developing world
    Morton TD
    J Emerg Med, 1992 7 11;10(4):485-8.
    PMID: 1430987
    The author spent 6 months as director of a major university hospital accident and emergency department in Kuala Lumpur, Malaysia. A brief summary of this experience is provided, followed by a series of recommendations based on the experience that may provide some guidance in future efforts to establish emergency medicine in developing areas of the world.
    Matched MeSH terms: Emergency Service, Hospital
  7. Fulltext Development and validation of the knowledge and clinical reasoning of acute asthma management in emergency department (K-CRAMED)
    Mohd Muzammil Ozair, Kamarul Aryffin Baharuddin, Saiful Azlan Mohamed, Wafaak Esa, Muhamad Saiful Bahri Yusof
    Education in Medicine Journal, 2017;9(2):1-17.
    MyJurnal
    Suboptimal management of asthma can lead to increase morbidity and mortality. Unfortunately, this has become global issue and approximately 40% of asthmatic patients received suboptimal management in emergency department. Therefore, this study aimed to develop a tool to assess knowledge and clinical reasoning of healthcare providers on acute asthmatic management in emergency setting.
    Method: The tool was developed via three phases: (a) domain identification, (b) domain blueprinting based the Global Initiative of Asthma (GINA) and the British Thoracic Society (BTS) guidelines, and (c) item generation for each domain for assessing knowledge and clinical reasoning. Three forms of validity evidence related to content, response process and internal structure were appraised. Content validity index (CVI), face validity index (FVI), and intraclass correlation coefficient (ICC) estimate the content validity, response process and internal structure of the tool.
    Results: A new tool was developed, named as Knowledge and Clinical Reasoning of Acute Asthma Management in Emergency Department (K-CRAMED), which assesses knowledge and clinical reasoning on three domains related to management of acute asthma – diagnosis, treatment and disposition. CVI values for the three domains were more than 0.83. FVI values for the three domains among doctors and paramedics were at least 0.83. The ICC between scores given by emergency specialists was 0.989 (CI 95% 0.982, 0.994, p-value < 0.001).
    Conclusion: The newly developed tool, named as K-CRAMED, is a valid tool to assess knowledge and clinical reasoning of healthcare providers who manage patients with acute asthma. Further validation is required to verify its validity in other setting.
    Matched MeSH terms: Emergency Service, Hospital
  8. Fulltext Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation
    Ahmad Khaldun, I., Mohd Fyzal, B., Soo, C. I., Yeap, B. T., Mohamed Faisal, A. H.
    Medicine & Health, 2017;12(2):357-362.
    MyJurnal
    The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious patient. Many reported cases of locked-in syndrome following neurotoxic snake-bite mimics brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming. His condition deteriorated, and was intubated and ventilated in the emergency department. He received a total of 33 vials of the Ophiophagus hannah monospecific antivenom and subsequently recovered well with no neurological deficit. Retrospectively, he was able to recall the events and while he was lying paralysed and intubated under minimal sedation in the intensive care unit. He described it as a terrifying and painful experience. This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming lock-in syndrome from brain dead. Patients are unable to respond to physical pain and require adequate analgesia. A patient suffering this highly distressing experience may require psychological support.
    Keywords: emergency, envenoming, neurotoxicity, snakebite
    Matched MeSH terms: Emergency Service, Hospital
  9. Fulltext Diagnosing pediatric intussusception through bedside ultrasound by novice emergency department sonographers: a case report
    Farah, N. A., Ismail, M. S.
    Medicine & Health, 2017;12(2):321-328.
    MyJurnal
    Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.
    Keywords: diagnosis, Emergency Department, intussusception, paediatric, ultrasound
    Matched MeSH terms: Emergency Service, Hospital
  10. Fulltext Experiences of the public on the services in emergency department: a qualitative study
    Aung,Khin Thandar, Fatin Izzati Saiful Bahri
    International Journal of Care Scholars, 2018;1(2):1-4.
    MyJurnal
    Objective: The purpose of this study was to explore the experiences of the public on the services provided in the Emergency Department (ED) of Hospital Tengku Ampuan Afzan (HTAA). Methods: An exploratory, descriptive design was used to understand public experiences on the services in the ED. Ten respondents who fit the inclusion criteria were selected using purposive sampling method during their visit to the ED. They were interviewed for 30 to 45 minutes and were audio-recorded with the permission of the participants. The general meaning and the tone conveyed by the respondents were determined through coding, descriptions, and the themes that emerged. Results: Four major themes emerged from the study including waiting time, ED staff, information regarding the ED, and expectation on the ED services. Conclusion: As a result, there is a need to improve the practices in the ED and a need for an awareness program on the real functions and services of the ED
    Matched MeSH terms: Emergency Service, Hospital
  11. Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel 'Red Box' system
    Saiboon IM, Singmamae N, Jaafar MJ, Muniandy BK, Sengmamae K, Hamzah FA, et al.
    Saudi Med J, 2014 Jul;35(7):718-23.
    PMID: 25028229
    To evaluate the effectiveness of a new patient flow system, `The Red Box` on the quality of patient care in respect of the time taken for the care to be delivered to the patient.
    Matched MeSH terms: Emergency Service, Hospital/organization & administration*
  12. Fulltext Audit of pain management in the emergency department
    Fathil SM, Soong NS, Mustafa NM, Arith A, Ng WN, Bahrum NA, et al.
    Med. J. Malaysia, 2011 Jun;66(2):89-91.
    PMID: 22106683 MyJurnal
    Pain management in Malaysian Emergency Departments has not been studied well. Convenience sampling was used to recruit 402 patients who presented with acute pain over a 2-week period. The 11-point Numerical Rating Scale was used to quantify pain. Pain relieving medications were prescribed to 178 patients (44.3%) in the Emergency Department. These patients had a median pain score of 7 on arrival. Nonsteroidal anti inflammatory drugs were the most commonly prescribed class of analgesic. Pain was found to be inadequately treated.
    Matched MeSH terms: Emergency Service, Hospital*
  13. Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia
    Awang R, Al-Sohaim SI, Zyoud SH, Khan HR, Hashim S
    Intern Emerg Med, 2011 Oct;6(5):441-8.
    PMID: 21750875 DOI: 10.1007/s11739-011-0662-z
    Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.
    Matched MeSH terms: Emergency Service, Hospital*
  14. Fulltext Outcomes of cardiopulmonary resuscitation performed in Emergency Department, Hospital Universiti Sains Malaysia
    Chew KS, Idzwan ZM, Hisamuddin NA, Kamaruddin J, Wan Aasim WA
    Med. J. Malaysia, 2008 Mar;63(1):4-8.
    PMID: 18935723 MyJurnal
    Despite the progresses made in the science of cardiopulmonary resuscitation, there is lack of published works on this area in the Malaysian context. This survey was done to look at the outcomes of all cardiopulmonary resuscitation performed in Emergency Department (ED), Hospital Universiti Sains Malaysia (HUSM). This is a one year cross-sectional study from March 2005-March 2006. All adult cardiac arrest cases with CPR performed in ED, HUSM were included in the survey. The end points are return of spontaneous circulation (ROSC) and survival to ward admission. Out of the total 63 cases of cardiac arrest with CPR performed, only 19 cases (30.2%) had ROSC after CPR performed on them. Eventually only six patients (9.5%) had survival to ward admission. Patients with shockable intial arrest rhythm has a significantly higher chance to achieve ROSC (60.0%) compared to non-shockable rhythms (24.5%) (p = 0.025). However, there was no different in survival to ward admission between shockable and non shockable rhythms groups. The survival after cardiac arrest is still dismally poor. Perhaps we should be more selective in initiating CPR especially for out of hospital cardiac arrest.
    Matched MeSH terms: Emergency Service, Hospital*
  15. History of the orthopaedic specialty in Singapore
    Satku K, Chacha PB, Low YP
    Ann. Acad. Med. Singap., 2002 Sep;31(5):551-7.
    PMID: 12395635
    The Orthopaedic specialty service in Singapore began in 1952 with the appointment of J A P Cameron to the chair of Orthopaedics at the University of Malaya and the simultaneous establishment of the Department of Orthopaedic Surgery at the General Hospital, Singapore. A second department--a government department of orthopaedic surgery was established in 1959, under the headship of Mr D W C Gawne also at the General Hospital, Singapore to cater to the increasing workload. Although orthopaedic services were already available at Alexandra Hospital, Tan Tock Seng Hospital and Toa Payoh Hospital from as early as 1974, the formal establishment of a Department of Orthopaedic Surgery in these hospitals took place only in 1977. The pioneering local orthopaedic surgeons--Mr W G S Fung, Mr K H Yeoh, and Mr V K Pillay--joined the orthopaedic service in 1961. In 1967, Prof Pillay and Mr Fung took the leadership role at the University Orthopaedic Department and Government Orthopaedic Department, General Hospital, Singapore, respectively. Subspecialty services in orthopaedic surgery began in the late 1970s, and currently, at least 7 subspecialties have developed to divisional status at one or more hospitals. In 2001, there were 92 registered Orthopaedic specialists and just over a third were in private practice.
    Matched MeSH terms: Emergency Service, Hospital/history
  16. Fulltext Patient attendance at a major accident and emergency department: are public emergency services being abused?
    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*
  17. Fulltext An audit on the assessment and management of acute bronchial asthma in the accident and emergency department of a district hospital
    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*
  18. Use and toxicity of traditional and complementary medicine among patients seeking care at an emergency department of a teaching hospital in Malaysia
    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*
  19. Fulltext Performance Assessment of the Mortality in Emergency Department Sepsis Score, Modified Early Warning Score, Rapid Emergency Medicine Score, and Rapid Acute Physiology Score in Predicting Survival Outcomes of Adult Renal Abscess Patients in the Emergency Department
    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*
  20. Secondary triage classification using an ensemble random forest technique
    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
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