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Shu B Chan

Publications and source records attributed to Shu B Chan.

9 recordsLinked to original sources
PubMed2006

Clinical guidelines, computed tomography scan, and negative appendectomies: a case series.

INTRODUCTION: Prior studies suggest that preoperative abdominal computed tomography (CT) scan can contribute to a low negative appendectomy rate. Our study objective was to evaluate cases of negative appendectomies for clinical criteria and CT use. METHODS: Retrospective 1-year study of all negative appendectomies at a community hospital. Data included clinical evidence for appendicitis as well as CT results if performed. RESULTS: Of 122 cases reviewed, 8 (6.6%) were negative appendectomies. Six were younger than 20 years. Four had a preoperative CT scan. Overall, 106 (87%) of 122 cases received preoperative CT and had a negative appendectomy rate of 3.8%. Sixteen cases did not have preoperative CT and had a negative appendectomy rate of 25% (odds ratio, 8.5; 95% confidence interval, 1.9-38.5; Fisher exact test P = .01). CONCLUSION: Patients who had a CT scan for suspected appendicitis had a lower rate of negative appendectomies than those who had no CT. Most of the negative appendectomies occurred in patients younger than 20 years.

Abdominal Pain↗
PubMed2005

Correlation between chest x-ray and B-type natriuretic peptide in congestive heart failure.

INTRODUCTION: B-Type natriuretic peptide (BNP) values greater than 400 pg/mL have high positive likelihood ratio (>10) for the diagnosis of clinical congestive heart failure (CHF). However, in patients with CHF, it is not known what correlation, if any, exists for the BNP levels above 400 pg/mL and the findings on the initial chest x-ray (CXR). METHODS: Retrospective review of emergency department patients with CHF and initial BNP greater than 400 pg/mL. Descriptive statistics were analyzed and logistic regression was performed. RESULTS: Fifty-four patients mean age of 81.7 (SD, 8.2), 64.8% women. The mean BNP was 1493 pg/mL (SD, 1106). Only 68.5% had a finding of CHF on CXR. Logistic regression showed no correlation (Wald P = .568; R 2 = 0.8%). CONCLUSION: In patients with clinical CHF, there is no correlation between very high BNP levels (>400 pg/mL) and CXR readings. Clinicians should not be surprised to find patients with very high BNP levels but negative CXR.

Aged↗
PubMed2005

Is emergent anti-hypertensive treatment beneficial in intracranial hemorrhage?

A retrospective chart review of adult patients with primary intracranial hemorrhage (ICH) was conducted to determine the effects of emergent anti-hypertensives on mortality. Data included mean arterial pressure (MAP), Glascow Coma Scale score (GCS), ICH size, and anti-hypertensive treatment. Multi-variable logistic regression determined the effect of anti-hypertensives on ICH mortality. Of 66 patients studied, the overall mortality was 30.3%. Mortality was 34.5% for patients initially treated with anti-hypertensives vs. 25.8% for patients not treated. After controlling for age, MAP, GCS, and ICH size, anti-hypertensives given within the first 6 h of presentation were associated with a reduction in mortality with a p value of 0.0375 and an odds ratio of 140 (95% confidence interval [CI] 1.332 to >999). However, this effect may not occur in patients presenting with a systolic blood pressure (SBP)<200 mm Hg. In conclusion, in patients with primary intracranial hemorrhage, there was a significant decrease in mortality associated with emergent anti-hypertensive therapy. A larger prospective study is needed to confirm these findings, define the subgroups that may benefit, and better determine the effect size.

Aged↗
PubMed2003

The use of head computed tomography in elderly patients sustaining minor head trauma.

The study objectives were to ascertain historical and clinical criteria differentiating intracranial injury (ICI) in elderly patients with minor head trauma (MHT), and determine applicability of current head computed tomography (CT) scan indications in this population. A 12-month retrospective chart review was performed at a community teaching hospital with 34,000 annual Emergency Department (ED) visits. Included were patients > or = 65 years old sustaining MHT with a Glasgow Coma Scale (GCS) score of 13-15 who had a CT scan performed during their hospital stay. Data included: injury mechanism, symptoms, signs, GCS, anticoagulation use or studies, presence of alcohol or drug, CT scan result, diagnosis, and outcome and intervention(s). There were 133 patients, with 19 (14.3%) suffering ICI. Four ICI patients required neurosurgical intervention. The mean age was 80.4 years and 66% were female. Four of 19 ICI patients (21%) had a GCS of 15, no neurologic symptoms, alcohol use or anticoagulation. Only 1 of 13 signs and symptoms correlated with ICI. In this study, no useful clinical predictors of intracranial injury in elderly patients with MHT were found. Current protocols based on clinical findings may miss 30% of elderly ICI patients. Head CT scan is recommended on all elderly patients with MHT.

Aged↗
PubMed2003

Whole body irrigation for contraband bodypackers.

GOALS: Investigate outcomes of contraband body packers treated with whole bowel irrigation (WBI) using oral polyethylene glycol (PEG). Compare with prior studies of treatments using mild laxatives and/or observation. BACKGROUND: Drug smuggling via the gastrointestinal tract has risks including sudden death. Other studies have reported complication rates between 4% and 22%. STUDY: Retrospective case series of patients body packing contraband, and treated with WBI using PEG solution. Outcome measures include length of hospital stay (LOS) and complications. Statistical inferences using Spearman rank correlation and Fisher Exact tests. RESULTS: Sixteen patients with mean age 27.9 (SD 8.8). There were 2 complications (12.5%) and no deaths. There was no significant difference in complication frequency when compared with other reported treatment methods (P = 0.57, P = 0.48, P = 1.0). Mean LOS was 49.4 hours (SD 29.6). There was no correlation between mean LOS and either PEG dose (P = 0.89), drug type (P = 0.76), packet quantity (P = 0.34), or packet weight (P = 0.99). CONCLUSIONS: In this limited case series, WBI with PEG was used to treat contraband body packers with no higher complication frequency than other reported methods. The drug type, packet quantity, packet weight, and PEG dose did not correlate with the length of hospital stay.

Adolescent↗
PubMed2002

Medical emergencies at a major international airport: in-flight symptoms and ground-based follow-up.

BACKGROUND: There is limited recent data about the treatments and outcomes of commercial airline passengers who suffer in-flight medical symptoms resulting in subsequent EMS evaluation. The study objectives are to determine incidence, post-flight treatments, outcomes, morbidity, and mortality of these in-flight medical emergencies (IFMEs). METHODS: A 1-yr retrospective study of emergency medical service (EMS), emergency department (ED), and inpatient hospital records of IFME patients from Chicago O'Hare International Airport was completed. All commercial passengers or crew with in-flight medical symptoms who subsequently activated the EMS system on flight arrival are included in the study. The main outcome measures are: in-flight sudden deaths, post-flight mortality, hospital admission rate, ICU admission rate, ED procedures, inpatient procedures, and discharge diagnoses. RESULTS: There were 744 IFMEs for an incidence of 21.3 per million passengers per year. The hospital admission rate was 24.5%. The ICU admission rate was 5.9%. There were five in-flight sudden deaths and six in-hospital deaths for an overall mortality rate of 0.3 per million passengers per year. Emergency stabilization procedures were required on 4.8% of patients. Cardiac emergencies accounted for 29.1% of inpatient diagnoses and 13.1% of all discharge diagnoses. CONCLUSIONS: The incidence of in-flight medical emergencies is small but these IFMEs are potentially lethal. Although the majority of IFME patients have uneventful outcomes, there is associated morbidity and mortality. These included in-flight deaths, in-hospital deaths, and emergency procedures. Cardiac emergencies were the most common of serious EMS evaluated in-flight medical emergencies.

Aerospace Medicine↗
PubMedDate not supplied

Outcomes in EMS-transported attendees from events at a large indoor arena.

OBJECTIVES: Many emergency departments (EDs) receive patients from concert or other mass gathering events. The study objective was to determine whether routine emergency medical services (EMS) transport to a hospital from an indoor arena facility is warranted. METHODS: Retrospective review of transport medical records from an approximately 20,000-seat arena in a major metropolitan area from January 1, 1998, to June 30, 1999. Outcomes studied included inpatient admission rate, diagnoses, treatments, and length of ED stay. RESULTS: The authors reviewed 96 patients transported from 29 separate concert or professional wrestling events. The mean age was 23.2 years (SD, 10.4 yr). Only three patients (3.1%, 95% confidence interval [CI], 0.65%-8.9%) required inpatient admission. The mean length of stay in the ED was 158 minutes (95% CI, 132-185). Thirty-one percent of the patients had diagnoses of alcohol or drug use; trauma accounted for 33%; and medical reasons represented 35% of transports. Alcohol and/or drug cases stayed in the ED 207 minutes (mean), which was 59% longer than trauma cases (130 min) and 47% longer than the 141 minutes for medical cases (p = 0.007). Rock concerts had 45% alcohol/drug-related cases versus 22% for pop concerts and 0% for professional wrestling events (p = 0.001). CONCLUSIONS: Patients transported from indoor arena events rarely result in inpatient admissions. Alcohol- and drug-related problems were the primary diagnoses in 31% of these patients and required the most time in the ED. Rock concerts had more alcohol and drug cases than other events.

Adolescent↗
PubMedDate not supplied

Effects of an educational intervention on prehospital pain management.

INTRODUCTION: Pain is a common symptom evaluated by emergency medical services (EMS) providers. Hospital pain management programs began in the early 1990s based on a multidisciplinary approach and principles of total quality improvement. To date, these programs have had limited exposure in the prehospital setting. OBJECTIVES: To evaluate the effects of a pain management educational intervention (EI) for paramedic caregivers. METHODS: All ambulance providers from ten urban and suburban fire departments and two private ambulance companies participated in a three-hour EI during a quality improvement project. A survey was performed prior to the EI and repeated one month after the EI. A two-month collection of EMS runs for pain complaints was performed prior to the EI and repeated one month after the EI. Data analysis was performed using descriptive statistics and chi-square tests. RESULTS: The authors reviewed 397 surveys and 439 EMS runs for pain. Overall, after the EI, paramedics' knowledge of basic pain management principles increased from 57.3% to 74.9% (17.5%; 95% confidence interval (CI): 14.9%-20.2%; p < 0.001). Paramedics' utilization of nonpharmacologic pain therapies improved by 32.2% (95% CI: 25.3%-39.2%; p < 0.001), but there was no significant change in the use of pain medication (20.2% to 24.5%). There were 51.0% (95% CI: 44.1%-57.9%; p < 0.001) improvement in documentation of pain severity, 24% (95% CI: 21.2%-26.8%; p < 0.001) improvement in documentation of pain characteristics, and 13% (95% CI: 7.4%-18.7%; p < 0.001) improvement in pain reassessment following intervention. CONCLUSION: As a result of a three-hour educational intervention, paramedics had an increased understanding of pain principles, were more likely to provide prehospital nonpharmacologic pain therapy, and were more likely to document the results of their interventions.

Adult↗