Anticoagulant rodenticide ingestion: Who will develop coagulopathy?

Introduction: Development of coagulopathy after anticoagulant rodenticide ingestion varies among patients. This study aimed to identify factors that were associated with coagulopathy after anticoagulant rodenticide ingestion. Methods: This was a retrospective cohort study, conducted in the Hong Kong Poison Information Centre. All patients who reported rodenticide exposure and presented to the Accident and Emergency Department from 1 January 2010 to 31 December 2019 were recruited. Coagulopathy was defined as International Normalized Ratio of 1.3 or above. Results: One hundred sixty-nine patients were included in the final analysis. The median age was 44 years old. Forty-nine patients developed coagulopathy (International Normalized Ratio ⩾1.3). Univariate analysis (at p < 0.05) showed that age (p = 0.003), ingestion of first-generation anticoagulant rodenticide (p = 0.017), ingestion of more than one pack (p < 0.001), intentional ingestion (p = 0.002), hypoalbuminemia (p < 0.001), elevated alanine aminotransferase level (p = 0.041) and abnormal estimated glomerular filtration rate (p = 0.005) on presentation, and co-ingestion with paracetamol (p = 0.018) were associated with coagulopathy after anticoagulant rodenticide ingestion. Among these, ingestion of more than one pack (p < 0.001; odds ratio = 19.8; 95% confidence interval = 6.78–65.7), ingestion of first-generation anticoagulant rodenticide (p = 0.006; odds ratio = 5.2; 95% confidence interval = 1.96–15.2), hypoalbuminemia (p < 0.001; odds ratio = 22.4; 95% confidence interval = 6.17–99.0) and elevated alanine aminotransferase level on presentation (p = 0.039; odds ratio = 7.11; 95% confidence interval = 1.58–33.1) were statistically significant in the multivariate analysis. Conclusion: Ingestion of more than one pack and ingestion of first-generation anticoagulant rodenticides were significantly associated with the development of coagulopathy after anticoagulant rodenticide ingestion. Patients who developed hypoalbuminemia or elevated alanine aminotransferase level as a result of anticoagulant rodenticide ingestion were also significantly associated with the development of coagulopathy.

Evaluation of the utilization of extracorporeal toxin removal in lithium poisoning patients in Hong Kong

Background: Extracorporeal toxin removal is used for enhanced elimination in severe lithium poisoning. The Extracorporeal TReatments In Poisoning workgroup provides recommendations on the use of extracorporeal toxin removal in poisoning. Objectives: Our aim was to identify the pattern for using extracorporeal toxin removal in managing lithium poisoning in Hong Kong and compare the outcomes in extracorporeal toxin removal-treated patients and non-extracorporeal toxin removal-treated patients if indicated for treatment as defined by The Extracorporeal TReatments In Poisoning criteria. Methods: Lithium poisoning presented between year 2009 and 2019 in Hong Kong Poison Information Centre (HKPIC) database was categorized into extracorporeal toxin removal-treated group and non-extracorporeal toxin removal-treated group. Comparative analyses were performed. Results: Among 112 lithium-poisoned patients, 21% were treated with extracorporeal toxin removal. Larger proportion of patients had fulfilled at least one Extracorporeal TReatments In Poisoning criteria for extracorporeal toxin removal in the extracorporeal toxin removal-treated group (87% vs 18%, p < 0.005). The extracorporeal toxin removal-treat group patients were more commonly presented with impaired consciousness, seizure and dysrhythmia ( p < 0.05). They also got higher admission (3.62 mmol/L vs 2.18 mmol/L, p < 0.05) and peak (4.15 mmol/L vs 2.28 mmol/L, p < 0.05) serum lithium concentrations, as well as a significantly higher serum creatinine concentration upon presentation (263.74 µmol/L vs 98.66 µmol/L, p < 0.05). Extracorporeal toxin removal-treat group patients more frequently had a severe poisoning outcome (91.3% vs 9%, p < 0.05) and developed complications (69.6% vs 13.5%, p < 0.05). Logistic regression identified seizure, peak serum lithium concentration, and serum creatinine concentration upon presentation as risk factors for severe poisoning outcome. In subgroup analysis on patients with at least one indication for extracorporeal toxin removal as defined by Extracorporeal TReatments In Poisoning criteria, the proportion of severe poisoning remained higher in the extracorporeal toxin removal-treated group (90% vs 43.7%, p < 0.05). Complication rate was not significantly different between the two groups. Conclusion: Clinically severe lithium poisoning patients were treated with extracorporeal toxin removal in Hong Kong. Extracorporeal TReatments In Poisoning criteria can serve as a reference in considering extracorporeal toxin removal treatment for lithium poisoning patients. Nevertheless, Extracorporeal TReatments In Poisoning criteria recommend more extracorporeal toxin removal treatment than it was actually done. Lithium poisoning patients with positive Extracorporeal TReatments In Poisoning criteria have been managed without extracorporeal toxin removal. No statistically significant adverse outcome was observed in these cases.

Pediatric poisoning pattern: A comparison of preadolescent and adolescent groups in Hong Kong over 3 years

Objective: To compare local poisoning patterns of preadolescents and adolescents. Methods: Retrospective cross-sectional study. Data collected through the Hong Kong Poison Information Centre (HKPIC) Poisoning Information and Clinical Management System (PICMS). Patients aged 10 to 17 years old from January 2016 to December 2018 were included and divided into preadolescent (10–12 years old) and adolescent (13–17 years old) groups. Statistical analysis for categorical variables was performed using chi-square test of independence, p < 0.05. Strength of association examined with Cramer’s V. Rate ratios with 95% confidence interval were used to determine nature of association, using preadolescents as comparison group. Results: A total of 703 cases were analyzed. There were 107 cases in the preadolescent group and 596 cases in the adolescent group. Three variables showed moderate association: intentional exposure (rate ratio: 2.91, 2.13–3.98), exposure in school (rate ratio: 0.30, 0.21–0.44), and the use of pharmaceuticals (rate ratio: 1.95, 1.57–2.44). The most common substance of exposure were analgesics (n = 213, 24.94%) and fumes, gases, and vapors (n = 19, 15.08%) in adolescents and preadolescents, respectively. Conclusion: Epidemiological difference still exists between preadolescents and adolescents. The association of adolescents with intentional poisoning, and the use of pharmaceuticals was highlighted. The study acts as a recent update of pediatric poisoning patterns and hopes to act as a reference for future studies.

Professional quality of life and resilience in emergency department healthcare professionals during COVID-19 in Hong Kong: A cross-sectional study

Background: The professional quality of life of healthcare professionals in emergency departments may be compromised during the COVID-19 pandemic. Objectives: This study aims to examine professional quality of life and resilience as well as their relationships among emergency department healthcare professionals in Hong Kong during the COVID-19 outbreak. Methods: This study employed a cross-sectional design. Healthcare professionals (doctors and nurses) working in emergency departments in Hong Kong were recruited via snowball sampling. The Professional Quality of Life Scale, version 5, and the 10-item Connor-Davidson Resilience Scale were used to assess their positive (compassion satisfaction) and negative (secondary traumatic stress and burnout) aspects of professional quality of life and self-reported resilience. Socio-demographics and work-related characteristics were also analysed. Results: A total of 106 participants provided valid responses. The results showed an overall moderate level of compassion satisfaction, secondary traumatic stress and burnout among emergency department healthcare professionals. The mean score of the 10-item Connor-Davidson Resilience Scale was 23.8. Backward linear regression analyses revealed self-reported resilience was the only significant predictor of compassion satisfaction (regression coefficient B = 0.875; p < 0.001), secondary traumatic stress (B = −0.294, p < 0.001) and burnout (B = −0.670; p < 0.001), explaining 70.6%, 18.5% and 59.8% of total variance, respectively. Conclusion: Emergency department healthcare professionals in Hong Kong experienced an overall moderate level of professional quality of life during the COVID-19 outbreak. Those with a higher level of self-reported resilience had better compassion satisfaction and lower levels of secondary traumatic stress and burnout. The results support the importance of developing interventions that foster resilience among this group of emergency department healthcare professionals to combat COVID-19.

An eLearning program to prepare residents for a rotation in pediatric emergency medicine: A qualitative study

Background: To meet ACGME-I (Accreditation Council for Graduate Medical Education–International) training and duty hour requirements, we converted our 3-week-long pediatric emergency medicine induction program to an eLearning program. Objectives: The study aimed to identify areas of the eLearning program residents perceived useful and the components that helped them prepare for clinical work. Methods: The qualitative study took place in a tertiary pediatric emergency department. Twenty-seven residents from family medicine, emergency medicine, and pediatric medicine participated in focus group discussions to explore how they perceived the eLearning program helped prepare them for work. The interviews were audio-recorded, and transcripts were analyzed and coded into categories and themes. Results: Four themes emerged from the data analysis: residents’ access to the eLearning program, instructional methods, eLearning design elements, and supplementary learning. Residents valued autonomy to control their pace of learning and use online features that matched their preferred learning styles. Design features such as the use of questions and quizzes helped stimulate learning, but attention had to be paid to the order of questions in the modules and the format of the questions. Written guidelines served as a good reference for learners and face-to-face sessions accompanying the eLearning program helped reinforce knowledge and offered opportunities to interact with faculty members to clarify questions. Conclusion: Systematic planning focusing on access, instructional methods, and design is essential when creating eLearning programs for residency training. eLearning programs can be enhanced by the incorporation of team-based learning and having accompanying written content to reference.

Sarcopenia measured with paraspinous muscle using computed tomography for predicting prognosis in elderly pneumonia patients

Background: In the elderly, diagnostic findings of pneumonia are often atypical. Computed tomography was recommended for the diagnosis of pneumonia in elderly patients. Recently, the usage of computed tomography as a screening tool for pneumonia in emergency departments has increased. Sarcopenia is defined as the loss of skeletal muscle mass and strength with aging. In this study, the association between sarcopenia and prognosis measured through computed tomography was evaluated compared to CURB-65. Methods: This study was conducted on patients diagnosed with pneumonia through computed tomography from 1 March 2018 to 31 March 2020. The paraspinous muscle size and attenuation were measured at a level located at the T12 pedicle level on axial computed tomography images. Paraspinous muscle size was presented as paraspinous muscle index. Differences in the prognostic performance among the paraspinous muscle size and attenuation, and CURB-65 were evaluated by the area under the receiver operating characteristic curve. Results: A total of 509 patients were included and 132 patients (25.9%) were admitted to the ICU, and 58 patients (11.4%) died in hospital. Paraspinous muscle index was the significant factor for predicting in-hospital mortality and ICU admission. The area under the receiver operating characteristic value of paraspinous muscle index for prediction of mortality was 0.738 and CURB-65 was 0.707. The area under the receiver operating characteristic of paraspinous muscle index and CURB-65 for predicting ICU admission were 0.766 and 0.704, respectively. Conclusion: As a method of measuring sarcopenia, paraspinous muscle index was superior to CURB-65 in elderly pneumonia patients. The use of computed tomography in predicting prognosis for elderly pneumonia patients will ease the economic burden.