To study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy. Design: Retrospective study in a two-month period. Setting: Accident & Emergency Department of a public general hospital, which had four in-patient specialties-Medicine, Surgery, Paediatrics and Orthopaedics. Subjects: All cases admitted through the emergency department in the study period. Main outcome measures: Degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis. Results: 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. Conclusion: 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.
To study the characteristics and outcome of geriatric patients presenting with fever to an emergency department in Hong Kong and to analyse the factors affecting their length of stay. Methods: Retrospective study. Patients aged ≥65 who complained of fever, or with temperature ≥37.5 o C (aural) presenting to the Accident and Emergency Department (AED) of Caritas Medical Centre in Hong Kong from 14 November 2006 to 13 December 2006 were enrolled. The demographic data, clinical information and outcomes were studied. The characteristics of short stay and long stay patients were compared. Results: There were 370 patients in the study. Their median age was 80. Of these patients, 64.9% were category 3 or above, i.e. urgent, emergent or critical. The most common chief complaints were fever, shortness of breath, dizziness and cough. The admission rate was 81.9%. The median length of stay in hospital was 4.3 days. The most common hospital discharge diagnoses were chest infection, urinary tract infection, and fever with unknown cause. The discharge rate within 48 hours was 24.6%. With further analysis, temperature, walking ability, triage category and neutrophil count were significantly different between short stay (≤48 h) and long stay (>48 h) patients. For those discharged alive either from the AED or ward, 20.1% re-attended the AED within 14 days of discharge, and 17.5% of those previously discharged were admitted again for fever or other problems. Conclusion: Elders with fever are a major challenge to the AED and health care facilities. The admission rate for this group of patients is usually high. Elders with poor walking ability, high triage category, high temperature and neutrophil count were prone to have longer stay. (Hong Kong j.emerg.
Background Patient with alleged fish bone ingestion with negative oropharyngeal examination requires an upper gastrointestinal (GI) endoscopy for definitive care. Aim To study the competency and cost-effectiveness in patients with alleged fish bone ingestion using fibre-optic endoscope by emergency physician. Method A retrospective study in patients with endoscopy for alleged fish bone ingestion for a period of six months from January to June 2001. A telephone survey was conducted specifically asking for post-endoscopy or fish bone ingestion related complications. Results Ninety-six patients were recruited in the study. There were 42 males and 54 females with a ratio of 1:1.3. The detection rate was 32%. Eighty-seven percent of the fish bones was retrieved, and 13% was dislodged. Over 90% of fish bones were found in oropharynx and laryngopharynx. In the telephone survey, 81 patients (84.4%) could be contacted by phone and they experienced uneventful outcome after endoscopy. Of those who could not be contacted, there was no documented attendance or admission in any other hospital (under Hospital Authority) according to the computer records in Clinical Management System. Ninety-six hospital bed-days, which were equal to $350,400, could be saved under our approach in alleged fish bone ingestion without admitting patients into surgical unit for treatment. Conclusion Emergency physician was competent enough in performing upper GI endoscopy, and this method of managing alleged fish bone ingestion was shown to be safe and cost saving.
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