Timothy H Rainer

The University of Hong Kong | HKU · Department of Emergency Medicine

Background Although the PSI and CURB-65 represent well-validated prediction rules for pneumonia prognosis, PSI was designed to identify patients at low risk and CURB- 65 patients at high risk of mortality. We compared the prognostic performance of a modified version of the PSI designed to identify high-risk patients (i.e., PSI-HR) to CURB-65 in pre...

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...

p>The original version of this Article contained errors in Table 1 and Table 3. In Table 1, in the group “Already taking antibiotics at emergency call, n (%)”, the number of patients in “Intervention (n = 62)” and “Control (n = 52)” were interchanged. The incorrect and correct values appear below. Incorrect:(Table preseneted.)</p

Background: The COVID-19 pandemic has been associated with excess mortality and reduced emergency department attendance. However, the effect of varying wave periods of COVID-19 on in-hospital mortality and length of stay (LOS) for non-COVID disease for non-COVID diseases remains unexplored. Methods: We examined a territory-wide observational coh...

Severe sepsis is a time critical condition which is known to have a high mortality rate. Evidence suggests that early diagnosis and early administration of antibiotics can reduce morbidity and mortality from sepsis. The prehospital phase of emergency medical care may provide the earliest opportunity for identification of sepsis and delivery of life...

Background The aerosol box and intubation tent are improvised barrier-enclosure devices developed during the novel coronavirus pandemic to protect health care workers from aerosol transmission. Objective Using time to intubation as a crude proxy, we aimed to compare the efficiency and usability of the aerosol box and intubation tent in a simulated...

Objective We aimed to evaluate and characterize the scale and relationships of emergency department visits and excess mortality associated with the early phase of COVID-19 pandemic for the territory of Hong Kong. Methods We conducted a territory-wide, retrospective, cohort study to compare the ED visits and related impact of the COVID-19 pandemic...

Introduction Interfacility transport with helicopter from remote island clinics to urban hospitals account for a significant portion of the Hong Kong Government Flying Service missions. Currently, doctor and nurse escorts are deployed as volunteers only during the daytime from every Friday to Monday and on public holidays. While most transport runs...

Background Variation in initial assessment methods at emergency departments in with primary care service models and a conflated terminology causes difficulties in assessing relative performance, improving quality or gathering evidence about safety and clinical effectiveness. We aim to describe and classify streaming pathways in emergency department...

Purpose Health policy in England has advocated the use of primary care clinicians at emergency departments to address pressures from rising attendances. Thisstudy explored senior managers’ perspective son funding mechanisms used to implement the policy and experiences of success or challenges in introducing GPs in or alongside emergency departments...

Background Accurate differentiation and prioritization in emergency department (ED) triage is important to identify high-risk patients and to efficiently allocate of finite resources. Using data available from patients with suspected cardiovascular disease presenting at ED triage, this study aimed to train and compare the performance of four common...

Background and objective Quality management of Acute Kidney Injury (AKI) is dependent on early detection, which is currently deemed to be suboptimal. The aim of this study was to identify combinations of variables associated with AKI and to derive a prediction tool for detecting patients attending the emergency department (ED) or hospital with AKI...

Doppler ultrasound technology is widespread in clinical applications and is principally used for blood flow measurements in the heart, arteries and veins. A commonly extracted parameter is the maximum velocity envelope. However, current methods of extracting it cannot produce stable envelopes in high noise conditions. This can limit clinical and re...

Older people have a high incidence of adverse outcomes after urgent care presentation. Identifying high-risk older patients early is key to targeting interventions at those patients most likely to benefit. This study used the Frailsafe three-point screening questions amongst older Emergency Department (ED) attendees. Consecutive unplanned ED attend...

Background: At times of increasing pressure on emergency departments, and the need for research into different models of service delivery, little is known about how to recruit patients for qualitative research in emergency departments. We aimed to collect evidence on patients’ experiences of different models using general practitioners in emergency...

Background: At times of increasing pressure on emergency departments, and the need for research into different models of service delivery, little is known about how to recruit patients for qualitative research in emergency departments. We report from one study which aimed to collect evidence on patients’ experiences of attending emergency departmen...

Aim: The epidemiology of Acute Kidney Injury (AKI) diagnosed in the Emergency Department (ED) is poorly described. This study describes the incidence, demographics and outcomes of patients diagnosed with AKI in the ED (ED-AKI). Methods: A prospective cohort study was completed in a University Teaching Hospital, (UK) between April and August 2016...

Background Sepsis is a common condition which kills approximately 44,000 people annually in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve outcomes. Paramedics frequently attend patients with sepsis, and are well placed to provide early diagnosis and treatment. We aimed to assess whether a multi-ce...

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...

Background In sport, concussion is assessed using the Sports Concussion Assessment Tool (SCAT) 5 and managed with return to play guidelines. Similar, user-friendly tools are rarely, if ever, used in the emergency department (ED). Objectives To evaluate a modified concussion assessment tool designed for the ED (ED-CAT) in patients presenting with a...

Background: Efficient assessment of patients after ischemic stroke has important reference value for doctors to choose appropriate treatment for patients. Our study aimed to develop a new prognostic model for predicting outcomes 3 months after ischemic stroke among Chinese Population. Methods: A prospective observational cohort study among ischemic...

Objective: There are few guidelines for clinical trials of interventions for prevention of post-traumatic osteoarthritis (PTOA), reflecting challenges in this area. An international multi-disciplinary expert group including patients was convened to generate points to consider for the design and conduct of interventional studies following acute kne...

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...

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...

Aim Sepsis is common; it kills at least 44 000 people every year in the UK. Early recognition and management of sepsis has been shown to reduce morbidity and mortality of people with sepsis. Paramedics frequently come into contact with patients with sepsis, and are well placed to provide early treatment. This feasibility study aims to find out whet...

Background: Sepsis is a common condition which kills between 36,000 and 64,000 people every year in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve the health and well-being of people with sepsis. Paramedics frequently come into contact with patients with sepsis and are well placed to provide early...

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...

Background: Increased mortality related to differences in delivery of weekend clinical care is the subject of much debate. Aims: We compared mortality following detection of AKI on week and weekend days across community and hospital settings. Design. A prospective national cohort study, with AKI identified using the Welsh National electronic AKI...

Objective: The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard. Me...

Background The current evaluation of patients with chest pain presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin. Objective We aimed to validate the diagnostic accuracy of a Thrombolysis in Myocardial Infarction (TIMI) score with single high-sensiti...

The ultrasonic cardiac output monitor (USCOM) is a noninvasive transcutaneous continuous wave Doppler method for assessing hemodynamics. There are no published reference ranges for normal values in adults (aged 18–60 years) for this device. This study aimed to (1) measure cardiovascular indices using USCOM in healthy adults aged 18–60 years; (2) co...

Background to the research Patients present to Emergency Departments (ED) with a spectrum of illness, many of which are life- threatening. The body has the ability to compensate in the early stages when things go wrong so that on the surface patients do not appear as sick as they really are. Under-diagnosis of severity of illness leads to under-tre...

Objective: The aim of this study was to assess the diagnostic accuracy of ED doctors with variable training levels in detecting acute appendicitis, without access to advanced imaging in admitted patients with acute abdominal pain in a university hospital of Hong Kong. Methods: A retrospective analysis was performed on data collected from prospec...

Background: Elevated levels of circulating plasma and urine leucine-rich-2-glycoprotein-1 (LRG1) protein has been found in patients with acute appendicitis (AA) and may be useful for diagnosis. This study aimed to investigate whether combined tests including circulating LRG1 mRNA levels improves the early diagnosis of AA. Methods: Between Decemb...

Four risk scores for stratifying patients with chest pain presenting to emergency departments (EDs) (namely Thrombolysis in myocardial infarction [TIMI], Global registry for acute coronary events [GRACE], Banach and HEART) have been developed in Western settings but have never been compared and validated in Chinese patients. We aimed to find out to...

Objectives: Many drug and fluid regimens in emergency medicine are weight dependent in adults, but no standard adult weight estimation tools exist. Paediatric weight is often estimated in emergency situations using methods based on age or height when direct measurement is not possible, and recently, methods based on mid-arm circumference (MAC) hav...

Background: older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care. Objective: to perform a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool, to determine its predictive value in identifying adults ≥65 years at risk of functio...

Objectives: To investigate the effects of an occupational therapy fall reduction home visit program for older adults admitted to the emergency department (ED) for a fall and discharged directly home. Design: Single-blind, multicenter, randomized, controlled trial. Settings: EDs in three acute care hospitals in Hong Kong. Participants: Indivi...

Background and objectives: Our aim was to use a national electronic AKI alert to define the incidence and outcome of all episodes of community- and hospital-acquired adult AKI. Design, setting, participants, & measurements: A prospective national cohort study was undertaken in a population of 3.06 million. Data were collected between March of 20...

Background: The aim of this study was to evaluate post-injury functional recovery over three years in patients with moderate and major trauma in Hong Kong. Methods: This is a multicentre prospective cohort study conducted in Hong Kong. The inclusion criteria were: trauma patients admitted to one of three trauma centres, with age ≥ 18 years, injury...

Objective The aim of the present study was to evaluate the finger counting method and compare its performance with four commonly used age-based weight estimation formulae in children aged 1–9 years presenting to the ED in Hong Kong. Methods A cross-sectional, observational study of children aged 1–9 years who presented to the ED of a tertiary refe...

Background: C-reactive protein (CRP) is increasingly being included in the diagnostic work-up for community-acquired pneumonia in primary care. Its added diagnostic value beyond signs and symptoms, however, remains unclear. We conducted a meta-analysis of individual patient data to quantify the added value of CRP measurement. Methods: We include...

Background: Early identification of stroke is crucial to maximize early management benefits in emergency departments. This study aimed to develop and validate a new stroke recognition instrument for differentiating acute stroke from stroke mimics in an emergency setting. Methods: A prospective observational cohort study among suspected stroke pa...

Background: There have been no randomised controlled trials that specifically evaluate the effect of a comprehensive programme with multidisciplinary input on patients who have just been discharged from hospital after treatment of acute exacerbation of COPD (AECOPD). The aim of this study was to assess whether a comprehensive care programme would...

Background: Chest pain patients commonly present to emergency departments (ED), and require either hospital admission and/or lengthy diagnostic protocols to rule-out myocardial infarction. We aimed to identify the best combination of add-on tests to high-sensitivity cardiac troponin (hs-cTnT) for predicting 30-day major adverse cardiac events (MAC...

Hypertension is the leading risk factor for the global burden of disease, yet more than 20 % of adults with hypertension are unaware of their condition. Underlying hypertension affects over 25 % emergency department attendees, and the condition is more commonly encountered in emergency departments than in primary care settings. Emergency department...

We evaluated the acceptability of an additional ad hoc influenza vaccination among the health care professionals following seasons with significant antigenic drift.Self-administered, anonymous surveys were performed by hard copy questionnaires in public hospitals, and by an on-line platform available to all healthcare professionals, from April 1st...

Background and Objectives Healthcare systems are organized very differently in Hong Kong (HK) and Guangzhou (GZ). This study compared managements of the emergency departments (ED) and one-year mortalities of ST-segment elevation myocardial infarction (STEMI) patients in two teaching hospitals in Guangzhou and Hong Kong. Methods Retrospective obser...

Objectives: This study aimed to investigate plasma concentrations of miR-124-3p and miR-16 as prognostic markers in emergency department patients with acute stroke. Design and methods: Plasma concentrations of miR-124-3p and miR-16 of 84 stroke patients (presenting to the emergency department within 24h from onset of symptoms) were determined by...

Background Pneumonia remains difficult to diagnose in primary care. Prediction models based on signs and symptoms (S&S) serve to minimize the diagnostic uncertainty. External validation of these models is essential before implementation into routine practice. In this study all published S&S models for prediction of pneumonia in primary care were ex...

TRIPOD Checklist for prediction model development and validation with added text excerpts. Some of the items were not applicable (NA) to the current study. (PDF)

Search strategies for PubMed, EMBASE and the Cochrane Library. (PDF)

In- and exclusion criteria of all model development studies and studies contributing IPD. (PDF)

Overview of methodological quality of included validation datasets according to QUADAS-2 assessment [24]. (PDF)

Diagnostic value of c-reactive protein for Pneumonia in primary care acute cough patients: An individual patient data meta-analysis. (PDF)

Prediction rules of included diagnostic models for pneumonia in primary care. (PDF)

Relative discriminative performance of pneumonia prediction models within datasets, measured as delta AUC. Numbers depict the difference of individual model’s AUC to the average AUC of the dataset. (PDF)

Background: Two recent double-blind randomized, controlled trials (RCTs) showed that oral steroids and nonsteroidal anti-inflammatory drugs have similar analgesic effectiveness for management of gout, but the trials had small sample sizes and other methodological limitations.