Lu-shan earthquake occurred at 8:02 am, on April 20th, 2013. The epicenter of earthquake was located in Lu-shan county, Ya’an city, Sichuan province, about 100 km from Chengdu along the Longmenshan fault zone in the same province heavily impacted by the 2008 Wenchuan earthquake. The earthquake has resulted in 196 people dead, 24 missing, at least 11,470 injured as of 14:30, April 24th, 2013. After Lu-shan earthquake, medical rescue teams were dispatched from the West China Hospital, Sichuan University to the stricken area. This article written by a member of the rescue team reported the difficult and dangerous rescue work and the performance of rescue members in the stricken area.
目的 探讨适用于儿童的JumpSTART检伤分类程序在大型车祸所致的含儿童群体伤中，对患儿受伤严重程度评估的实践意义。 方法 回顾性分析2010年12月－2012年12月因大型车祸所致群体伤（3例以上伤员，至少含1例14岁以下儿童）就诊的20例患儿的病历资料。入急诊时对患儿行JumpSTART检伤分类程序，入院确诊后行国际公认的能较准确反映伤情严重程度的损伤严重度评分（ISS）。比较两种评估方法的一致性。 结果 JumpSTART检伤分类程序与ISS评分一致性较好（Kappa=0.474，P=0.003）。 结论 JumpSTART检伤分类程序可在含儿童的群体伤医疗急救时，初步评估患儿伤情严重度，从而进行检伤分类。
Hospital incident command system is a series of management systems for emergencies response of hospitals from the United States. Some hospitals in many countries have applied this system, but it has not yet been applied in China. In the process of responding to the coronavirus disease 2019 epidemic, West China Hospital of Sichuan University managed coronavirus disease 2019 patients through a standardized and programmatic model using the concept and framework of hospital incident command system, which included organizing hospital incident management team, carrying out incident action plan, space management, personnel management, material management and information management, in order to carry out standardized and procedural crisis response. This article introduces these management measures of West China Hospital of Sichuan University, aiming to provide a reference for establishing a more complete hospital emergency management system in line with China’s system in the future.
ObjectiveTo systematically review the diagnostic value of procalcitonin (PCT) for tuberculous pleural effusion. MethodsWe electronically searched CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library and EMbase from inception to April, 2013, to collect the literature about the diagnostic value of PCT for tuberculous pleural effusion compared with gold standard (positive outcomes of mycobacterium tuberculosis culture). Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. MetaDiSc 1.4 were used to conduct the meta-analysis. ResultsEight studies were finally included. The results of meta-analysis showed the pooled sensitivity and specificity were 0.63 (95%CI 0.58 to 0.68) and 0.76 (95%CI 0.70 to 0.81), respectively. The positive likelihood ratio and negative likelihood ratio were 2.72 (95%CI 1.48 to 5.02) and 0.49 (95%CI 0.29 to 0.82), respectively. The diagnostic odds ratio (DOR) was 5.77 (95%CI 1.89 to 17.58). And the SROC AUC was 0.79. Heterogeneity was mainly derived from the QUADAS score and Begg's test showed there was no presence of publication bias. ConclusionPCT is a potential marker in the diagnosis of benign and tuberculous pleural effusion, which can be used to determine diagnosis identification of tuberculous pleural effusion.
目的 探讨修正创伤评分（RTS）、CRAMS评分及院前伤情评分（PHI）对于群体伤患者死亡的评估作用。 方法 回顾性分析2011年8月－2012年8月就诊且记录完整的45例群体伤患者的病历资料，根据病历记录计算RTS、CRAMS及PHI评分，并记录患者是否死亡。绘制受试者工作特征曲线并计算出曲线下面积；根据约登指数筛选出各个评分适宜的截断值，据此计算3种创伤评分的灵敏度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值并进行比较。将患者按照性别、年龄分为亚组进行对比分析。 结果 RTS曲线下面积最大，且与参考线下面积对比差异有统计学意义（P=0.016），与另外两种评分比较其差异有统计学意义。 结论 RTS较CRAMS及PHI评分对于群体伤患者死亡预测具有更高的价值。
ObjectiveTo evaluate the feasibility of clipless laparoscopic cholecystectomy (LC) to patients with calculous cholecystitis in acute inflammation stage. Methods The clinical data of 169 patients with calculous cholecystitis in acute inflammation stage who underwent clipless LC from December 2008 to July 2010 were analyzed. ResultsAll patients were successfully operated by LC except one case who suffered from gallbladder perforation and a conversion to open surgery was performed. The operation time ranged from 25-70 min (mean 38 min). The blood loss ranged from 10-200 ml (mean 22 ml). Peritoneal drainage was done in 38 patients, and the drainage time ranged from 1-6 d (mean 1.8 d). The time to out-of-bed activity was at 2 h after operation and the hospitalization time was 3-7 d (mean 3.5 d). There was no complication such as bile duct injury, hemorrhage, billiary leakage, and intra-abdominal infection. ConclusionWith improvement of operator’s experiences and skills, the clipless LC becomes feasible and safe for patients with calculous cholecystitis in acute inflammation stage.
目的 探讨H2受体拮抗剂和质子泵抑制剂（PPI）缓解急性胃黏膜损伤的时效性研究。 方法 对2008年1月－2010年1月在急诊科就诊的98例急性乙醇中毒后胃黏膜损伤患者，随机分为对照组50例，治疗组48例。常规给予休息、保暖，补液，维持水、电解质、酸碱平衡，维持循环功能等治疗基础上，对照组给予H2受体拮抗剂治疗，治疗组给予PPI治疗。通过观察急性胃黏膜损伤患者上消化道症状及体征，记录不同饮酒及饮酒量，并根据患者就诊时间及不同饮酒组治疗后上消化道症状完全缓解时间进行比较。 结果 治疗组上消化道症状缓解所需时间与对照组比较差异有统计学意义（P＜0.001），不同饮酒组上消化道症状缓解时间上差异有统计学意义（P=0.000）。 结论 PPI在缓解急性乙醇中毒所致胃黏膜损伤的时效上更明显，具有临床价值。
ObjectiveTo evaluate the prognosis factors for early death (within 60 days) of acute myocardial infarction (AMI) patients for early identification and prevention of the disease. MethodsWe analyzed the information of AML patients who were admitted to the emergency department between May 2009 and July 2010, and analyzed their clinical data, such as gender, age, prehospital time, myocardial enzyme, electrocardiogram, complications, whether the patients had thrombolysis therapy, time of thrombolysis, end point observation and time of death, ect. Cox multivariate survival analysis was performed with the use of SPSS 18.0 software. ResultsSeventy-one cases were collected with one of them excluded for fragmented data. After analysing, we found that patients' age and isoenzymes of creatine kinase (CK-MB) level were prognosis factors for early death. Further analysis showed that the relative risk (RR) of age was 1.166 (P=0.023), and the RR of CK-MB was 1.001 (P=0.004). ConclusionPatients' age has predictive value for early death of AML. More attention should be paid to AML patients with advanced age. Detecting myocardial enzymes levels, especially the CK-MB level, is significant for predicting early death. Other indicators need to be further explored due to the possible limitation of our study.
ObjectiveCurrently, simple triage and rapid transport (START) is widely used as a method to evaluate the severity of mass casualty events in a disaster. Modified physiological triage tool (MPTT) and modified physiological triage tool-24 (MPTT-24) are newly introduced triage methodologies that may offer improvements over START. However, the feasibility and accuracy of these two methods cannot be adequately assessed without sufficient data support, whether in earthquakes or other disasters. Our study aimed to analyze the value of the three triage methodologies in mass casualty events due to earthquakes.MethodsA total of 36 604 injured patients from the West China Hospital database were evaluated using START, MPTT and MPTT-24, respectively. The triage methodologies were then evaluated based on death and ICU acceptance, using the area under the receiver-operator curve (AUC). The sensitivity and specificity of the three methodologies were compared under different standards and correlations with the injury severity score (ISS) were analyzed. ResultsFor deaths, the AUCs for the triage methodologies were 0.711, 0.775 and 0.686 for START, MPTT, and MPTT-24, respectively. For ICU acceptance, the AUCs of the triage methodologies after correction for bias were 0.579, 0.618 and 0.603. The correlation coefficients of the triage methodologies and ISS score were 0.041, 0.087, and 0.115.ConclusionsMPTT is superior to START and MPTT-24 in the evaluation of critically ill patients in mass casualty events caused by earthquakes.