Timothy Rainer
Cardiff University, School of Medicine, Faculty Member
Research Interests: Hong Kong, Critical Care, Coma, Prospective studies, Humans, and 15 moreFemale, Resuscitation, Male, Glasgow Coma Scale, Follow-up studies, Clinical Sciences, Aged, Prevalence, Middle Aged, Public health systems and services research, Reflex, Asian Continental Ancestry Group, Cough, Critical Illness, and Gagging
Introduction: Internationally, standard care of patients with severe sepsis consists of early detection, early antimicrobial therapy, and aggressive intravenous fluid therapy to maintain tissue oxygenation and perfusion. In this... more
Introduction: Internationally, standard care of patients with severe sepsis consists of early detection, early antimicrobial therapy, and aggressive intravenous fluid therapy to maintain tissue oxygenation and perfusion. In this retrospective study, we aimed to examine the management of patients with severe sepsis in a local university hospital emergency department before and after the implementation of a sepsis management guideline. Method: We collected data on the management and outcome of patients during a three-month period before the implementation of a sepsis guideline (October-December 2009). We then collected similar data one year after the implementation (October-December 2010). Key sepsis management areas and in- hospital mortality rates were compared, as were length of resuscitation, three-month mortality rate, hospital length of stay (LOS) and intensive care unit (ICU) LOS. Results: Data from 115 patients were collected in the pre-implementation group, while data on 102 patients were collected for the post-implementation group. There were more patients with hypoperfusion in the post-implementation cohort (25.2% vs. 40.2%, p=0.019). There was no difference in background characteristics, average lactate value, average MAP or number of hypotensive patients between the two groups. Significantly more antibiotics were given after the intervention (13.0% vs. 23.5%, p=0.045) and more patients had a lactate level measured (43.0% vs. 73.5%; p<0.001). There was a trend towards better survival for a subgroup of patients with hypoperfusion (48.0% vs. 29.2%, p=0.060). Conclusions: Implementation of a sepsis guideline leads to more antibiotics being given and more lactate measurement in the emergency department. (Hong Kong j.emerg.med. 2015;22: 163-171)
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Recently, much interest has developed in the potential use of plasma DNA as a diagnostic and monitoring tool. We hypothesized that plasma DNA is increased in patients with trauma and may be prognostic in such patients. We studied 84... more
Recently, much interest has developed in the potential use of plasma DNA as a diagnostic and monitoring tool. We hypothesized that plasma DNA is increased in patients with trauma and may be prognostic in such patients. We studied 84 patients who had sustained an acute blunt traumatic injury. We measured plasma DNA by a real-time quantitative PCR assay for the beta-globin gene. Blood samples were collected at a median time of 60 min following injury. Blood samples were also obtained from 27 control subjects. The median plasma DNA concentrations in the control, minor/moderate trauma (Injury Severity Score <16; n = 47), and major trauma (Injury Severity Score > or =16; n = 37) groups were 3154 kilogenome-equivalents/L, 13 818 kilogenome-equivalents/L, and 181 303 kilogenome-equivalents/L, respectively. Plasma DNA concentrations in patients with adverse outcomes, including acute lung injury, acute respiratory distress syndrome, and death, had 11. 6- to 12-fold higher plasma DNA co...
Research Interests: Clinical Chemistry, DNA, Humans, Medical Biotechnology, Female, and 13 moreClinical, Blood sampling, Male, Acute respiratory distress syndrome, DNA analysis, Acute Lung Injury, ROC Curve, Clinical Sciences, Biological markers, Sensitivity and Specificity, Confidence Interval, Severity of Illness Index, and Injury Severity Score
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Chest pain is a common complaint among emergency department (ED) patients. The Thrombolysis in Myocardial Infarction (TIMI) and front door TIMI (FDTIMI) scores are used to risk stratify chest pain patients in many Western countries; they... more
Chest pain is a common complaint among emergency department (ED) patients. The Thrombolysis in Myocardial Infarction (TIMI) and front door TIMI (FDTIMI) scores are used to risk stratify chest pain patients in many Western countries; they have not been validated in patients with undifferentiated chest pain in Asia. Our objective was to establish the relationship between the TIMI and FDTIMI scores and the 30 day rate of major adverse cardiac outcomes (MACE) in Chinese patients presenting to the ED with chest pain. Prospective, single-center, observational cohort study of consecutive patients presenting with chest pain from July 2009 until March 2010 to a Hong Kong university hospital ED. Data collected included patient characteristics, TIMI items and past medical and medication history. Primary outcome was MACE within 30 days of presentation. MACE was a composite outcome of any of the following: death (all causes), readmission with myocardial infarction, acute coronary syndrome not di...
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Much research interest has been shown in recent years for the development of molecular diagnostic strategies based on the analysis of DNA/RNA molecules that are present in the plasma/serum of human subjects. Reported applications include... more
Much research interest has been shown in recent years for the development of molecular diagnostic strategies based on the analysis of DNA/RNA molecules that are present in the plasma/serum of human subjects. Reported applications include the diagnosis, prognostication or monitoring of malignancies and pregnancy-associated complications. While researchers have speculated that cell death is a potential mechanism that leads to the release of DNA/RNA into the circulation, studies have demonstrated that indeed increased amounts of plasma DNA and RNA could be detected in patients sustaining acute traumatic injuries. The degree of plasma DNA elevation correlated with the severity of injury. Similarly, plasma DNA concentrations have been shown to correlate with indices of prognostic significance in patients with acute stroke. It is expected that new diagnostic markers based on plasma RNA detection could be developed for the evaluation of acute pathologies.
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As RNA is labile, we investigated whether circulating RNA in human plasma may be present in a particle-associated form. Blood was collected from 27 healthy individuals and 16 hepatocellular carcinoma (HCC) patients. The plasma from each... more
As RNA is labile, we investigated whether circulating RNA in human plasma may be present in a particle-associated form. Blood was collected from 27 healthy individuals and 16 hepatocellular carcinoma (HCC) patients. The plasma from each individual was processed by two means: filtration through filters with different pore sizes (from 5 microm to 0.22 microm) and ultracentrifugation. We assessed plasma RNA content by a real-time quantitative reverse transcription-PCR assay for glyceraldehyde-3-phosphate dehydrogenase (GAPDH) transcripts and plasma DNA by a real-time quantitative PCR assay for the beta-globin gene. The plasma GAPDH mRNA concentrations in the healthy individuals were significantly different in every pair of these filter sizes (P <0.05 for each pair). Overall, the plasma GAPDH mRNA concentration was higher by a median of 15-fold (interquartile range, 10- to 24-fold) in the paired unfiltered sample than in the sample filtered through a 0.22 microm filter. In contrast, ...
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The workload of emergency departments (ED) continually changes in response to presentations, overcrowding and availability of expertise and investigations. To investigate changes in ED presentations and care processes, and the... more
The workload of emergency departments (ED) continually changes in response to presentations, overcrowding and availability of expertise and investigations. To investigate changes in ED presentations and care processes, and the relationship of patient demand and ED staff resources to waiting times and processing times. Retrospective analysis of prospectively collected administrative data from January 1999 to April 2005 in an emergency department in a university teaching hospital in Hong Kong. All patients attending the emergency department during the study period were included. Monthly attendance data were retrieved and analysed to determine both qualitative and quantitative changes in the patterns of presentation to the ED using prospectively gathered data. Total ED attendances decreased by 25% during the study with little seasonal variation. The admission rate and the use of ambulances increased steadily and significantly. Medical patients are increasing proportionately, but trauma...
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Point-of-care (POC) diagnostics brings tests nearer to the site of patient care. The turnaround time is short, and minimal manual interference enables quick clinical management decisions. Growth in POC diagnostics is being continuously... more
Point-of-care (POC) diagnostics brings tests nearer to the site of patient care. The turnaround time is short, and minimal manual interference enables quick clinical management decisions. Growth in POC diagnostics is being continuously fueled by the global burden of cardiovascular and infectious diseases. Early diagnosis and rapid initiation of treatment are crucial in the management of such patients. This review provides the rationale for the use of POC tests in acute coronary syndrome, heart failure, human immunodeficiency virus, and tuberculosis. We also consider emerging technologies that are based on advanced nanomaterials and microfluidics, improved assay sensitivity, miniaturization in device design, reduced costs, and high-throughput multiplex detection, all of which may shape the future development of POC diagnostics.
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Infection and multiple organ failure remain the principal causes of late mortality after trauma despite advances in the resuscitation of injured patients. Because a better understanding of postinjury leukocyte trafficking is essential to... more
Infection and multiple organ failure remain the principal causes of late mortality after trauma despite advances in the resuscitation of injured patients. Because a better understanding of postinjury leukocyte trafficking is essential to the development of possible therapeutic measures aimed at preventing these complications, we have performed a study of one factor in the early posttrauma endothelial adhesion behavior of monocytes, lymphocytes, and neutrophils: their cell surface expression of L-selectin (CD62L). We have also studied the plasma levels of soluble L-selectin in these patients. Two venous blood samples were taken from each of 41 trauma patients at median times of 1 and 20 hours after injury. The study group included 16 patients with major (Injury Severity Score (ISS) &gt; or = 16), 17 with moderate (ISS = 9-15), and 8 with minor (ISS &lt; 9) trauma. Cell surface L-selectin was measured on leukocyte subsets by staining with specific fluorescent-labeled monoclonal antibodies to CD62L and using flow cytometry. Both the percentage of cells expressing the molecule and the mean channel fluorescence were measured. Levels of soluble L-selectin were measured in the plasma, sampled concurrently, by enzyme-linked immunosorbent assay. Monocytes, lymphocytes, and neutrophils all showed an early increase in cell surface L-selectin expression as measured by mean channel fluorescence (p &lt; 0.0001, p &lt; 0.001, and p &lt; 0.0001, respectively), and this persisted in later samples taken at a median 20 hours after injury (p &lt; 0.0001,p &lt; 0.0001, and p &lt; 0.01). Only monocytes showed an increased percentage of cells expressing the molecule in the early phase (p &lt; 0.02), and this remained in the later phase (p &lt; 0.001). Monocytes also showed a further significant increase in mean channel fluorescence (p &lt; 0.02) between the two periods. No significant changes in levels of plasma soluble L-selectin were found at either stage. An increase in the expression of L-selectin on each of three leukocyte populations has been demonstrated in the early phase after trauma. This would tend to promote rolling behavior of leukocytes and increase their contact with the vascular endothelium. There were marked differences in the later responses of the three populations, which may represent differential control of their behavior.
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Although surface adhesion molecules mediate leucocyte-endothelial interactions at sites of inflammation, relatively little is known of the factors which increase the expression of L-selectin in circulating leucocytes. The expression of... more
Although surface adhesion molecules mediate leucocyte-endothelial interactions at sites of inflammation, relatively little is known of the factors which increase the expression of L-selectin in circulating leucocytes. The expression of leucocyte L-selectin increases during acute stress events such as injury and is temporally related to an early neuroendocrine response. This study investigates whether adrenaline increases the expression of L-selectin on monocytes, neutrophils and lymphocytes in vitro and whether these effects are mediated via beta-adrenoceptors. A total of 20 ml of blood was withdrawn from 28 healthy volunteers (21 males) with a mean age of 29 years (range 23-67 years). Adrenaline at physiological doses mimicking trauma (0-200 nmol/l) was added to whole blood prior to immunofluorescent staining and analysis by flow cytometry. Propranolol (50 microl of 2 x 10(-5) M) was also added to separate tubes prior to incubation with adrenaline. Saline (40 microl 0.9% solution) was used as a control. Expression is described firstly as percentage of cells expressing L-selectin and secondly as average intensity (mean channel fluorescence, mcf) per cell expressing CD62L. Summary measures were used to analyse the data. A significant increase in both the percentage of monocytes expressing L-selectin and mean channel fluorescence of L-selectin was evident with adrenaline in vitro (P &amp;amp;lt; 0.0001). Maximal increases occurred at 100 nmol/l adrenaline when a 9% increase in the percentage of monocytes expressing L-selectin and a 23% increase in mean channel fluorescence were observed. These effects were both blocked by propranolol (P &amp;amp;lt; 0.0001). No significant differences were observed for neutrophils or lymphocytes except for a slight increase in the percent neutrophils expressing L-selectin, and a small decreasing trend in percent lymphocytes expressing L-selectin. Adrenaline upregulates the surface expression of L-selectin on monocytes in vitro, an effect which is partially mediated by beta-adrenoceptors. As monocytes initiate early aspects of the inflammatory response, these findings suggest that beta-blockade may have an inhibitory role for certain aspects of leucocyte trafficking.
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Research Interests: Pain, Adolescent, British medical history, Humans, Cost Effectiveness Analysis, and 18 moreFemale, Male, Cost effectiveness, Randomised Controlled Trial, Morphine, Aged, Middle Aged, Adult, Adverse Event, Cost Benefit Analysis, BMJ, Emergencies, Ketorolac, Pain Measurement, Emergency Department, Confidence Interval, Extremities, and Outcome measure
Early diagnosis of acute coronary syndrome (ACS) is important to guide appropriate therapy at a time when it is most likely to be of value. Accurate prognostic and risk stratification will facilitate high-risk patients to have early... more
Early diagnosis of acute coronary syndrome (ACS) is important to guide appropriate therapy at a time when it is most likely to be of value. Accurate prognostic and risk stratification will facilitate high-risk patients to have early advanced diagnostic investigations and early appropriate interventions in a cost-effective and efficient manner, while those patients at low risk of ACS complications do not need such costly diagnostic tests and unnecessary hospital admission. Recent investigations have demonstrated that elevation of biomarkers upstream from acute-phase biomarkers, biomarkers of plaque destabilization and rupture, biomarkers of myocardial ischemia, necrosis, and dysfunction may provide an earlier assessment of patient risk and identify patients with higher risk of having an adverse event. This review provides an overview of the pathophysiology and clinical characteristics of several well-established biomarkers as well as emerging biomarkers that may have potential clinical utility in patients with ACS. Such emerging biomarkers hold promise and need to be more thoroughly evaluated before utilization in routine clinical practice.
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This study aimed to establish learning profiles for noninvasive transcutaneous Doppler ultrasound. Four trainees attended a 2-h lecture, followed by a 15-min demonstration on a volunteer and a 30-min hands-on workshop in a small group... more
This study aimed to establish learning profiles for noninvasive transcutaneous Doppler ultrasound. Four trainees attended a 2-h lecture, followed by a 15-min demonstration on a volunteer and a 30-min hands-on workshop in a small group setting. Then, they underwent hands-on practice on 50 participants without supervision. The skill acquisitions in terms of signal magnitude, signal quality, and measurement time of the trainees were evaluated through 50 assessments, and were compared with that of a trainer with extensive experience on the use of an ultrasonic cardiac output monitor acting as a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. The learning profile for each individual trainee was analyzed using the cumulative sum graphical method. Four trainees performed ultrasonic cardiac output monitor on 50 participants. All trainees attained proficiency after 18-36 assessments to achieve aortic signal magnitude and quality comparable with the trainer. It requires a minimum of nine assessments to obtain three aortic scans within 5 min with 95% success rates. Only half of the trainees achieved competence in pulmonary scans and the minimum number of assessments required was 36. A minimum of 22 assessments were required for three pulmonary scans within 10 min with 95% success rates. A substantial period of learning needs to be undertaken to achieve proficiency on the use of noninvasive transcutaneous Doppler ultrasound. Cumulative sum analysis is a useful tool for ongoing quality assessment during medical education and training in practical procedures on an individual basis.
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A multidetector computed tomography (MDCT) was installed in our department. Referral rates, examination protocols and detection rates of abnormal findings in CT examinations for cervical spine trauma 6 months before and 6 months after... more
A multidetector computed tomography (MDCT) was installed in our department. Referral rates, examination protocols and detection rates of abnormal findings in CT examinations for cervical spine trauma 6 months before and 6 months after MDCT installation were compared to look for changes in practice. Retrospective analysis of all CT cervical spine examinations in patients with multiple trauma over two contiguous 6-month periods: from July 2003 to December 2003 (helical CT) and from January 2004 to June 2004 (MDCT). Variables recorded were number of CT examinations performed, scan plane coverage and traumatic abnormalities detected. Phantom dosimetry measurements for cervical spine examination in both helical CT and MDCT were compared. One hundred and fifty four patients underwent cervical spine CT during these periods. Helical CT period: of 91 patients undergoing CT cervical spine examination for trauma, 65 (71%) were complete cervical examinations and 26 (29%) were level-specific examinations. Eight patients (9%) had cervical spine fracture, six of which were apparent on radiographs. Dose estimations for thyroid, lens and breast were 24.76, 1.86 and 0.21 mGy, respectively, for complete cervical spine examinations. MDCT period: of 63 patients who underwent CT cervical spine examination for trauma, 61 (97%) were complete examinations and 2 (3%) were level-specific examinations. Six patients (11%) had cervical spine fracture, three of which were apparent on radiographs. Dose estimations for thyroid, lens and breast were 75.8, 9.7 and 0.7 mGy, respectively, for complete cervical spine examinations, which were notably higher than those for helical CT. After installation of MDCT, clinical requests for complete examination of the cervical spine following trauma increased. This changing trend resulted in a significantly higher radiation dose to thyroid, lens and breast.
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The importance of the early recognition of shock in patients presenting to emergency departments is well recognized, but at present, there is no agreed practical definition for undifferentiated shock. The main aim of this study was to... more
The importance of the early recognition of shock in patients presenting to emergency departments is well recognized, but at present, there is no agreed practical definition for undifferentiated shock. The main aim of this study was to validate an a priori clinical definition of shock against 28-day mortality. This prospective, observational, cross-sectional, single-center study was conducted in Hong Kong, China. Data were collected between July 1, 2012, and January 31, 2013. An a priori definition of shock was designed, whereby patients admitted to the resuscitation room or high dependency area of the emergency department were divided into 1 of 3 groups-no shock, possible shock, and shock. The primary outcome was 28-day mortality. Secondary outcomes were in-hospital mortality or admission to the intensive or coronary care unit. A total of 111 patients (mean age, 67.2 ± 17.1 years; male = 69 [62%]) were recruited, of which 22 were classified as no shock, 54 as possible shock, and 35 ...
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We have investigated the impact of primary decompressive craniectomies on neurological outcomes after adjusting for other predictive variables. We have collected data from trauma patients with acute subdural hematomas in a regional trauma... more
We have investigated the impact of primary decompressive craniectomies on neurological outcomes after adjusting for other predictive variables. We have collected data from trauma patients with acute subdural hematomas in a regional trauma center in Hong Kong over a 4-year period. Patient risk factors were investigated using logistic regression. Out of 464 patients with significant head injuries, 100 patients had acute subdural hematomas and were recruited for analysis. Forty-four percent of the patients achieved favorable neurological outcomes after 6 months. Favorable neurological outcomes at 1 year were related to age, pupil dilatation, and motor GCS scores at the time of admission. In the 34 patients who underwent evacuation of acute subdural hematomas, primary decompressive craniectomy was not associated with favorable neurological outcomes. Primary decompressive craniectomy failed to show benefit in terms of neurological outcomes and should be reserved for cases with uncontrolled intra-operative brain swelling.
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PurposeThis study aims at determining whether there is a seasonal pattern of falls among older people in Hong Kong and exploring the possible mechanisms underlying the seasonal pattern.
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Background: Severe acute respiratory syndrome (SARS) is associated with a lymphopenia, thrombocytopenia and neutrophilia and suspected cases may be admitted to hospital on the basis of such abnormalities. Laboratories may report changes... more
Background: Severe acute respiratory syndrome (SARS) is associated with a lymphopenia, thrombocytopenia and neutrophilia and suspected cases may be admitted to hospital on the basis of such abnormalities. Laboratories may report changes as percentages or absolute counts. Objective: To investigate whether absolute or percentage differential counts were more predictive of patients with SARS pneumonia. Design: Prospective observational study. Setting: SARS clinic of an emergency department in Hong Kong. Subjects and methods: Whole blood and differential counts were performed on 506 patients presenting to a SARS screening clinic. Ninety-six patients subsequently developed SARS pneumonia. Results: Sixty-nine patients had abnormal lymphocyte absolute counts on first attendance at clinic of which 37 (54%) developed SARS pneumonia. This compared with 142 subjects with abnormal percentage lymphocyte values of which 50 (35%) developed SARS pneumonia. The area under the ROC curve for absolute ...
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Research Interests: Singapore, Hong Kong, United Kingdom, Biological Sciences, Seasonality, and 16 moreHumans, Infection Control, Perceived Risk, Pandemic Influenza, Female, Male, Vaccine, Health Care Workers, Vaccination, Great Britain, Professional Practice, Questionnaires, Influenza Vaccine, Side Effect, Cross Sectional Studies, and Health Personnel
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Research Interests: Adolescent, Hong Kong, Prospective studies, Humans, Female, and 17 moreThorax, Pneumonia, Male, ROC Curve, Clinical Sciences, Intensive Care Unit, Aged, Middle Aged, Adult, Prognosis, Community Acquired Pneumonia, Low Risk, Observational Study, Predictive value of tests, Positive predictive value, Emergency Department, and Severity of Illness Index
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Research Interests: Emergency Medicine, Adolescent, Hong Kong, Prospective studies, Early Warning, and 18 moreHumans, Female, Resuscitation, Male, Young Adult, Follow-up studies, ROC Curve, Clinical Sciences, Cardiopulmonary Resuscitation, Intensive Care Unit, Aged, Middle Aged, Adult, Public health systems and services research, Survival Rate, Intensive Care Units, Emergency Department, and Critical Illness
Acute coagulopathy is a common clinical complication after trauma, and contributes to posttraumatic multiple organ failure. The phenomenon may be due to the effect of stress hormones on platelet adhesion molecule expression after trauma.... more
Acute coagulopathy is a common clinical complication after trauma, and contributes to posttraumatic multiple organ failure. The phenomenon may be due to the effect of stress hormones on platelet adhesion molecule expression after trauma. Catecholamine levels correlate with injury severity scores and changes of L-selectin expression on leucocytes, whilst adrenaline (ADR) (epinephrine) alone also activates platelets. This study thus investigates the effects of ADR and noradrenaline (NOR) (norepinephrine) on platelets, at doses similar to those found in the plasma of normal and trauma subjects. Blood was taken from 19 healthy subjects and placed in tubes containing sodium citrate. Anti-platelet-bound fibrinogen monoclonal antibody was used to identify the activated platelets while anti-CD41 was used to identify platelets with and without activation. Five increasing concentrations of ADR and NOR (1, 3, 5, 10, 30 nmol/l) as well as one negative control (0.9% normal saline) and one positive control (10 micromol/l adenosine diphosphate/ADP) were prepared for the stimulation. A whole blood protocol was used in order to minimize any activation artefacts, which might be created by centrifugation. The percentage of platelets expressing fibrinogen receptors increased significantly with ADR and NOR even at the lowest dose (1 nmol/l) and continued to increase in a dose-dependent manner. Although the effect of ADR was greater than NOR in stimulating platelets to express fibrinogen receptors, the average number of fibrinogen receptors on each platelet was constant. ADR and NOR activated platelets to express fibrinogen receptors at doses that are similar to those found in the plasma of trauma patients.
Research Interests: Flow Cytometry, Linear models, Fibrinogen, Humans, Epinephrine, and 14 moreFemale, Resuscitation, Male, Platelet activation mechanism, Norepinephrine, Clinical Sciences, Adult, Public health systems and services research, Monoclonal Antibody, Wounds and Injuries, Healthy Subjects, Multiple Organ Failure, Adenosine Diphosphate, and Injury Severity Score
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Research Interests: Risk assessment, Humans, Female, Resuscitation, Male, and 12 moreClinical Sciences, Middle Aged, Adult, Public health systems and services research, Retrospective Studies, Risk Stratification, Risk Assessment, Blood Transfusion, Hemorrhage, Wounds and Injuries, Severity of Illness Index, and Injury Severity Score
Reference ranges for vital signs may differ significantly among children of different ethnic origins. (1) To validate the Advanced Paediatric Life Support (APLS) age-based vital signs reference ranges in Chinese children in Hong Kong. (2)... more
Reference ranges for vital signs may differ significantly among children of different ethnic origins. (1) To validate the Advanced Paediatric Life Support (APLS) age-based vital signs reference ranges in Chinese children in Hong Kong. (2) To derive age-based centile curves for systolic blood pressure, heart rate and respiratory rate for Chinese children. (3) To summarize the reference ranges in a table format appropriate for applying APLS to ethnic Chinese patients. A cross-sectional study was performed on a population of healthy Chinese children recruited from 8 kindergartens and 6 primary schools in Hong Kong. Trained operators visit the sites to obtain measurements. Age-groups: small toddlers (12-23 months); pre-school (24-59 months); and school (60-143 months). Z-test was used to assess statistical significance for proportions of each parameter falling outside the APLS reference range. One-sample t-test was used for comparison with APLS means according to age-groups. LMS Chartmaker Pro v2.3 software was used to describe the data in centile curves. A total of 1353 patients (55.1% boys) were included. For heart rate, systolic blood pressure and respiratory rate respectively, 34.1%, 55.9% and 55.7% of corresponding measurements were outside the APLS age-based reference ranges. In the &amp;amp;amp;amp;amp;amp;amp;amp;#39;pre-school&amp;amp;amp;amp;amp;amp;amp;amp;#39; and &amp;amp;amp;amp;amp;amp;amp;amp;#39;school&amp;amp;amp;amp;amp;amp;amp;amp;#39; age-groups, the mean value for blood pressure is significantly higher, and the mean values for heart rate and respiratory rate significantly lower, in comparison to APLS mean values. Independently derived vital signs reference ranges are more appropriate for use when applying APLS to Chinese patients in Hong Kong.