Hong Kong Journal of Emergency Medicine

Acute urinary retention (AUR) is a common urological presentation to emergency departments (ED). An ambulatory care protocol had been developed allowing trial without catheterization (TWOC) instead of admission to hospital after catheterization in the ED. This study aimed to evaluate the efficacy of the ambulatory care protocol for patients with AUR. The secondary aim was to identify any independent predictor(s) for successful weaning of urinary catheter in a short duration.

This was a prospective cohort study. A total of 143 male patients presenting with an episode of AUR underwent urinary catheterization once. Those who were unable to pass urine afterwards were catheterized again and discharged home with a urinary catheter in-situ (Day 0). On Day 3, ability of spontaneous urination was assessed. If failed, spontaneous urination was assessed again on Day 6.

Successful TWOC was recorded in 50.3% of the 143 patients after first catheterization. The cumulative successful rates for first (Day 3) and second (Day 6) follow-ups were 76.9% and 79.0%, respectively. Among the associated predictors, only the urine retention volume on first catheterization was found to be independently associated with successful TWOC, using binary logistic regression (p=0.001).

The ambulatory care protocol was successful in weaning off urinary catheter for 50.3% of patients with AUR after first catheterization and a further 26.6% on Day 3, making a cumulative success rate of 76.9%. Those who failed TWOC on Day 3 would get little benefit on further trials. The first catheterization volume was independently associated with the chance of successful TWOC.

Biomarkers play an important role in the early diagnosis, risk stratification and management of patients with the acute coronary syndrome.

The objective of this study was to evaluate the clinical reliability of heart-type fatty acid-binding protein (h-FABP) in identifying patients with the acute coronary syndrome in the early hours of chest pain.

Creatine kinase (CK-MB) (in laboratory), troponin T (in laboratory) and h-FABP (with point-of-care test CardioDetect®) were performed on 791 patients who presented with chest pain with duration since onset ranging from 20 minutes to 12 hours.

Data of the 791 patients were analysed. h-FABP had a higher sensitivity of 75.76% and a specificity of 96.97% compared with 58.59% and 98.84% for troponin T and 68.69% and 97.54% for CK-MB respectively (in the first 6 hours). Conclusion: h-FABP was found to be a better biomarker of cardiac necrosis in the early hours in the diagnosis of non-conclusive ECG in patients with acute myocardial infarction. (Hong Kong j.emerg.med. 2009;16:141–147)

To explore why patients in Hong Kong seek medical advice from the emergency department (ED) and to identify the methods by which patients would prefer to be updated on the likely waiting time for medical consultation in the ED.

The study recruited 249 semi-urgent and non-urgent patients in the ED of Prince of Wales Hospital from 26th September 2005 to 30th September 2005 inclusive. A convenience sample of subjects aged ≥15 years old in triage categories 4 or 5 were verbally consented and interviewed by research nurses using a standardized questionnaire.

From 1715 potential patients, 249 were recruited ad hoc (mean age 44 years [SD18]; 123 females). About 63% indicated that an acceptable ED waiting time was less than or equal to two hours, and 88% felt that having individual number cards and using a number allocation screen in the ED waiting area would be useful. Perceived reasons for attending the ED rather than other health care providers such as primary health care or the general outpatient clinic (GOPC) included: a desire for more detailed investigations (56%); a perception that more professional medical advice was given in the ED (35%); patients were under the continuing care of the hospital (19%); and patients were referred to the ED by other health care professionals (11%). Notably, 26% of participants had considered attending the GOPC prior to attending the ED. Patients educated to tertiary level expected a shorter waiting time than those educated to lesser degrees (p=0.026, Kruskal-Wallis test). Suggestions were made on how to provide a more pleasant ED environment for the wait for consultations, which included the provision of a television screen with sound in the waiting area (43%), more comfortable chairs (37%) and health care promotion programs (32%).

Patients chose ED services because they believed they would receive more detailed investigations and more professional medical advice than available alternatives. Clear notification of the likely waiting times and enhancement of comfort before consultation are considered desirable by patients. Enhanced public education about the role of the ED and making alternatives to ED care more accessible may be useful in reducing inappropriate ED attendances in Hong Kong.