Colin A Graham

Colin A Graham
The Chinese University of Hong Kong | CUHK · Accident and Emergency Medicine Academic Unit

MBChB MPH MD

About

455
Publications
63,946
Reads
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4,910
Citations
Additional affiliations
August 2007 - July 2016
The Chinese University of Hong Kong
Position
  • Professor of Emergency Medicine
May 2004 - present
The Chinese University of Hong Kong
May 2004 - present
Prince of Wales Hospital, Hong Kong
Position
  • Consultant in Emergency Medicine

Publications

Publications (455)
Article
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Objective Nepal female community health volunteers (FCHVs) were the first available health personnel in communities during the 2015 Nepal earthquakes. This study explored the facilitating factors and barriers of the FCHVs during health emergencies. Methods In-depth interviews with 24 FCHVs and 4 health managers from 2 districts in Nepal (Gorkha an...
Article
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Purpose Trauma remains a major cause of morbidity and disability worldwide; however, reliable data on the health status of an urban Asian population after injury are scarce. The aim was to evaluate 1-year post-trauma return to work (RTW) status in Hong Kong. Methods This was a prospective, multi-center cohort study involving four regional trauma c...
Article
Background Most headache presentations to emergency departments (ED) have benign causes; however, approximately 10% will have serious pathology. International guidelines recommend that patients describing the onset of headache as ‘thunderclap’ undergo neuroimaging and further investigation. The association of this feature with serious headache caus...
Article
Background and aim: Migraine headache is commonly diagnosed in emergency departments (ED). There is relatively little real-world information about the epidemiology, investigation, management, adherence to therapeutic guidelines and disposition of patients treated in ED with a final diagnosis of migraine. The primary aim of the current study is to...
Article
Objective: To describe the epidemiology of nontraumatic headache in adults presenting to emergency departments (EDs). Background: Headache is a common reason for presentation to EDs. Little is known about the epidemiology, investigation, and treatment of nontraumatic headache in patients attending EDs internationally. Methods: An international...
Article
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Background Trauma remains a leading cause of death and effective trauma management within a well-developed trauma system has been shown to reduce morbidity and mortality. A trauma registry, as an integral part of a mature trauma system, can be used to monitor the quality of trauma care and to provide a means to compare local versus international st...
Article
Objective: To describe the patterns of opioid use in patients presenting to the emergency department (ED) with nontraumatic headache by severity and geography. Background: International guidelines recognize opioids are ineffective in treating primary headache disorders. Globally, many countries are experiencing an opioid crisis. The ED can be a...
Article
Objective To describe the characteristics, assessment and management of older emergency department (ED) patients with non-traumatic headache. Methods Planned sub-study of a prospective, multicentre, international, observational study, which included adult patients presenting to ED with non-traumatic headache. Patients aged ≥75 years were compared...
Article
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Background: While the pharmacy workforce is the third largest professional healthcare group worldwide, the pharmacy workforce landscape remains unclear in post-conflict areas in sub-Saharan Africa. Method: Key informants were selected for semi-structured interviews due to their role in providing pharmacy services in the selected country: the Cen...
Article
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PurposeThe purpose was to investigate long-term health impacts of trauma and the aim was to describe the functional outcome and health status up to 7 years after trauma.Methods We conducted a prospective, multi-centre cohort study of adult trauma patients admitted to three regional trauma centres with moderate or major trauma (ISS ≥ 9) in Hong Kong...
Article
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Background: Truly patient-centred care needs to be aligned with what patients consider important, and is highly desirable in the first 24 h of an acute admission, as many decisions are made during this period. However, there is limited knowledge on what matters most to patients in this phase of their hospital stay. The objective of this study was...
Article
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Disasters disproportionately impact poor and marginalised populations due to greater vulnerability induced by various risk determinants, such as compromised living conditions, language barriers, and limited resources for disaster risk management. Health Emergency and Disaster Risk Management (Health EDRM) emphasises a people- and community-centred...
Article
Background: The impact of a pandemic on unplanned hospital attendance has not been extensively examined. The aim of this study is to report the nationwide consequences of the COVID-19 pandemic on unplanned hospital attendances in Denmark for 7 weeks after a 'shelter at home' order was issued. Methods: We merged data from national registries (Civ...
Article
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Purpose Hong Kong (HK) trauma registries have been using the Trauma and Injury Severity Score (TRISS) for audit and benchmarking since their introduction in 2000. We compare the mortality prediction model using TRISS and Revised Injury Severity Classification, version II (RISC II) for trauma centre patients in HK. Methods This was a retrospective...
Article
Introduction: Quick and reliable assessment of acute patients is required for accurate triage. The temperature gradient between core and peripheral temperature could possibly instantly provide information on circulatory status. Methods: Adult medical patients, who did not receive supplementary oxygen, attending two emergency departments, had a t...
Article
Purpose: This systematic review investigates whether infrared thermography (IRT) can measure systemic vasoconstriction and addresses the value of IRT in assessing circulatory deficiency and prognoses. Methods: Design was based on the PRISMA criteria and a systematic search of 6 databases was performed. Results: Of 3,198 records, five articles...
Article
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The Sendai Framework for Disaster Risk Reduction 2015–2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster...
Article
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Background Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged...
Article
Objective Lower respiratory tract infection (LRTI) is a frequent cause of dyspnoea in EDs, and is associated with considerable morbidity and mortality. We described and compared the management of this disease in Europe and Oceania/South‐East Asia (SEA) cohorts. Methods We conducted a prospective cohort study with three time points in Europe and Oc...
Article
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Background The safety and effectiveness of intramuscular olanzapine or haloperidol compared to midazolam as the initial pharmacological treatment for acute agitation in emergency departments (EDs) has not been evaluated. Methods A pragmatic, randomised, double-blind, active-controlled trial was conducted from December 2014 to September 2019, in si...
Article
Background The coronavirus disease 2019 (COVID-19) pandemic has been enormously disruptive and harmful to people around the world, but its impact on other illnesses and injuries has been more variable. To evaluate the ramification of infectious disease outbreaks on major traumatic injuries, we compared changes in the incidence of major trauma cases...
Article
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Background Hong Kong rates of bystander cardiopulmonary resuscitation are very low by international standards. Several Hong Kong secondary schools have begun incorporating cardiopulmonary resuscitation training into their curriculums for teachers and students. Objective This study aimed to explore secondary school cardiopulmonary resuscitation pro...
Article
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Background: As health systems across the world respond to the coronavirus disease 2019 (COVID-19), there is rising concern that patients without COVID-19 are not receiving timely emergency care, resulting in avoidable deaths. This study examined patterns of self-reported health service utilization, their socio-demographic determinants and associat...
Article
Objective Intravenous antimicrobial therapy within 1 h of the diagnosis of septic shock is recommended in international sepsis guidelines. We aimed to evaluate the association between antimicrobial timing and mortality in patients presenting to the ED with septic shock. Methods Post‐hoc analysis of 1587 adult participants enrolled in the Australas...
Article
Objectives: To describe the epidemiology and outcomes of non-traumatic dyspnoea in patients aged 75 years or older presenting to emergency departments (EDs) in the Asia-Pacific region. Methods: A substudy of a prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong an...
Article
Objectives: Guideline recommended treatments for chronic conditions are thought to reduce ED presentations. Method: We used data from 1958 ED patients with dyspnoea to describe medication use in patients with chronic conditions. Results: A total of 1233 (63.5%) patients had one or more of: chronic obstructive pulmonary disease 547 (28%), asthm...
Article
The COVID-19 pandemic has produced significant changes in emergency medicine patient volumes, clinical practice, and has accelerated a number of systems-level developments. Many of these changes produced efficiencies in emergency care systems and contributed to a reduction in crowding and access block. In this paper, we explore these changes, analy...
Article
Background: We aim to compare the prognostic value of Quick Sepsis-Related Organ Failure Assessment (qSOFA) and the previous Systemic Inflammatory Response Syndrome (SIRS) criteria, the National Early Warning Score (NEWS) and along with their combinationsin the emergency department (ED). Methods: This single-centre prospective study recruited a con...
Article
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Objectives Little is known about the value of routine clinical assessment in identifying patients with coronavirus disease 2019 (COVID‐19) in the emergency department (ED). We aimed to compare the exposure history, signs and symptoms, laboratory, and radiographic features of ED patients who tested positive and negative for COVID‐19. Methods This w...
Preprint
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(1) Background: It is unclear whether the reported presenting clinical features of coronavirus disease 2019 (COVID-19) are useful in identifying high-risk patients for early testing and isolation in the emergency department (ED). We aimed to compare the exposure history, clinical, laboratory, and radiographic features of ED patients who tested posi...
Article
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Effective critical appraisal of medical research requires training and practice. Evidence-based medicine provides a framework for standardised review of manuscripts of nearly any research design. Online resources and communities exist to provide free access to electronic search engines and critical appraisal of emergency medicine and non-emergency...
Article
Objective The objective of this study is to apply machine learning algorithms for real-time and personalized waiting time prediction in emergency departments. We also aim to introduce the concept of systems thinking to enhance the performance of the prediction models. Methods Four popular algorithms were applied: (i) stepwise multiple linear regre...
Article
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED). Guidelines recommend administration of inhaled bronchodilators, systemic corticosteroids and antibiotics along with non-invasive ventilation (NIV) for patients with respiratory acidosis. AIM: To determine compliance with guideline re...
Article
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Study design is critical to ensure that research questions are answered in an appropriate and rational manner for all aspects of health, but particularly in emergency care. Appropriate study design selection is one of the most critical decisions to make at the earliest stage of a research project; once this is clear, much of the methodology and sam...
Article
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Background Emergency nurse practitioners have traditionally been reluctant to treat acute red eyes in Hong Kong emergency departments. The Edinburgh Red Eye Diagnostic Algorithm is the only validated tool to assist non-ophthalmologists to make diagnoses. Objectives This study investigates the utility of a modified version used by emergency nurse p...
Article
Background Violent crime rates in China are low by global standards, but the occurrence and fear of violence against medical professionals has affected the morale and workplace environment of frontline medical staff working in busy emergency departments across the country. We aimed to document workplace violence against emergency medicine personnel...
Article
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Background Similar to many Asian cities, there is no statutory provision for the determination of the duty borne by bystander first aiders when assisting victims in Hong Kong. Objectives The aim of this study was to explore the views of a Good Samaritan Law by first-aid learners in Hong Kong. Methods A cross-sectional survey was conducted among f...
Article
Objectives Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED). Guidelines recommend administration of inhaled bronchodilators, systemic corticosteroids and antibiotics along with non‐invasive ventilation (NIV) for patients with respiratory acidosis. We aimed to determine compliance with guideline...
Article
Full-text available
Objectives Capillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement of capillary lactate measured using handheld analysers (CL-Nova and CL-Scout+ measured by Nova and Lactate Scout+ analyzers) and the...
Conference Paper
The diagnosis and emergency management of patients with shock (poor end organ perfusion with reduced tissue oxygen delivery, usually associated with systolic hypotension) is difficult even in optimum circumstances. The challenge is multiplied when patients have to be managed in overcrowded and poorly resourced emergency departments (ED). In Hong Ko...
Article
Objective Asthma exacerbations are common presentations to ED. Key guideline recommendations for management include administration of inhaled bronchodilators, systemic corticosteroids and titrated oxygen therapy. Our aim was to compare management and outcomes between patients treated for asthma in Europe (EUR) and South East Asia/Australasia (SEA)...
Article
Background: Trauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong. Methods: We report the five year follow up results...
Article
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Background: To determine the validity of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) in the prediction of outcome (in-hospital and 1-month mortality, intensive care unit (ICU) admission, and hospital and ICU length of stay) in adult patients with or without suspected infections where qSOFA was calculated and reported; Methods: Cochran...
Article
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Background The global travel and tourism industry has been rapidly expanding in the past decades. The traditional focus on border screening, and by airline and cruise industries may be inadequate due to the incubation period of an infectious disease. This case study highlights the potential role of the hotel industry in epidemic preparedness and re...
Article
Introduction: Emergency departments (EDs) play an important role in the early identification and management of sepsis. Little is known about local EDs' processes of care for sepsis, adoption of international recommendations, and the impact of the new Sepsis-3 definitions. Methods: Structured telephone interviews based on the United Kingdom Sepsi...
Article
Background: We believe errors in the risk assessment of acutely ill patients occur because only vital signs without concurrent functional capacity are considered. We, therefore, developed the PARIS risk score based on blood Pressure, Age, Respiratory rate, loss of Independence and oxygen Saturation. Objectives: Validation of the PARIS score in f...
Article
Objective: The primary objective of this study was to describe the epidemiology and management of dyspneic patients presenting to emergency departments (EDs) in an international patient population. Our secondary objective was to compare the EURODEM and AANZDEM patient populations. Patients and methods: An observational prospective cohort study w...
Article
Introduction: Modern automated external defibrillators (AEDs) are designed to prevent shock delivery when excessive motion produces rhythm disturbances mimicking ventricular fibrillation (VF). This has been reported as a safety issue in airline operations, where turbulent motion is commonplace. We aimed to evaluate whether all seven AEDs can deliv...
Article
Background: With the aging population, the number of older patients with multiple injuries is increasing. The aim of this study was to understand the patterns and outcomes of older patients admitted to a major trauma centre in Hong Kong from 2006 to 2015, and investigate the performance of the trauma team activation (TTA) criteria for these elderl...
Article
Background: Glasgow Coma Scale (GCS) is one of the most commonly used patient assessment tools. This study aimed to determine whether an assessment aid can improve the GCS scoring accuracy by helicopter rescuers in Hong Kong. Methods: In this randomised controlled trial, Air Crewman Officers (ACMOs) of Government Flying Service in Hong Kong were...
Article
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Background: Hong Kong (HK) and Guangzhou (GZ) are cities in China with different healthcare systems. This study aimed to compare 30-day and 6-month mortality and characteristics of patients with suspected cardiac chest pain admitted to two emergency departments (ED) in HK and GZ. Methods: A prospective observational study enrolled patients with...
Article
A short-cut review was carried out to establish the diagnostic accuracy of blood biomarkers as an alternative to imaging for the diagnosis of ischaemic stroke. Nine studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these...
Article
Introduction: Shortness of breath is a common presenting symptom to the emergency department (ED) that can arise from a myriad of possible diagnoses. Asthma is one of the major causes. Objective: To describe the demographic features, clinical characteristics, management and outcomes of adults with an emergency department (ED) diagnosis of asthma...
Article
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Background Soft tissue injuries commonly present to the emergency department (ED), often with acute pain. They cause significant suffering and morbidity if not adequately treated. Paracetamol and ibuprofen are commonly used analgesics, but it remains unknown if either one or the combination of both is superior for pain control. Objectives To inves...
Article
Background and objective: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation to emergency departments (ED) but data regarding its epidemiology and outcomes are scarce. We describe the epidemiology, clinical features, treatment and outcome of patients treated for AECOPD in ED. Methods: This was a planned...