Hospital Seeing More Personal Mobility Device Accidents and Serious Injuries Despite Active Mobility Act.

INTRODUCTION: E-scooters or personal mobility devices (PMDs) have recently been growing in popularity in Singapore. These devices can be especially helpful for those who have reduced mobility or who need to move between several relatively near locations multiples times per day or who simply appreciate the added convenience of having another transportation option. The increasing popularity of PMD has met with growing public concern over safety. Singapore government passed the Active Mobility Act (AMA) in January 2017 to regulate the usage of PMD. In Khoo Teck Puat Hospital, PMD-related accident has increased year on year by 20%-30%. Our study is to compare the incidence and severity of PMD-related accidents before and after the implementation of the AMA. MATERIALS AND METHODS: A retrospective study of patients presented to the emergency department (ED) of Khoo Teck Puat Hospital for PMD-related accidents between November 2014 and October 2017. In year 1 of the study, we included patients presenting between November 2014 and October 2015. In years 2 and 3, we included patients presenting between November 2015 and October 2016 and November 2016 and October 2017, respectively. Data collected included demographic information, type of device used and impact, outcome, and injury severity score (ISS). RESULTS: A total of 697 PMD-related accidents were seen in our center. We observed an increasing trend of accidents with significant injuries. There were 157 accidents reported in year 1, 233 in year 2, and 307 in year 3. The mean age of patients increased from 28 ± 15 years (range, 5-89 years) in year 1 to 33 ± 15 years (range, 4-83 years). Most patients were males (61.8% in year 1, 76.8% in year 2, and 73.3% in year 3) and Chinese (55.4% in year 1, 62.7% in year 2, and 65.5% in year 3), followed by Malays, Indians, and others. Devices commonly associated with injury were E-scooters, skateboards, and E-bicycles. E-scooters accidents had increased drastically from 12.1% in year 1 to 58.3% in year 3, but E-bicycles and other PMD accidents had decreased in year 3. Most patients were injured from falling off their devices (83.4% in year 1, 83.7% in year 2, and 79.5% in year 3), followed by collisions. Most patients arrived to the ED with own transports and were triaged to the patient acuity category 3 or 4. Most injuries were mild, with ISS <9 (97.5% in year 1 and 94.9% and 94.1% in year 2 and 3, respectively). The most common PMD-related injuries involved external injuries, followed by upper and lower extremities injuries. For more severe injuries (ISS ≥9), the number had increased from 4 in year 1 to 18 in year 3. Most patients were discharged. The number of patients required admissions increased from 12 to 44 in year 3, with two high-dependency or intensive care unit admissions. The mean hospital stay reduced from 5.0 ± 6.0 days to 3.6 ± 4.1 days, with the survival rate remained at 100%. There was only one fatality was reported in year 2. CONCLUSION: There is an increase in injuries and severity of PMD accidents despite AMA being implemented in January 2017. More need to be done to ensure the safety of PMD-related use in Singapore footpaths and roads.

Injury patterns associated with personal mobility devices and electric bicycles: an analysis from an acute general hospital in Singapore.

INTRODUCTION: The increasing popularity of personal mobility devices (PMDs) and electric bicycles (e-bikes) in Singapore has met with growing public concern over safety. Following the passing of the Active Mobility Bill, there remains a gap in the local literature in terms of injury patterns arising from the use of these devices. METHODS: A retrospective study was conducted on the Singapore National Trauma Registry (SNTR) from the emergency department of an acute hospital from 1 January 2016 to 31 December 2016. All patients with injuries related to the use of PMDs and e-bikes were included. Data captured included demographic information, device used and injury severity score (ISS). RESULTS: The 259 patients identified had a mean age of 32.1 years and a male predominance. Most (83.4%) were injured from falling off their devices. Devices commonly associated with injury were scooters, skateboards and motorised bicycles. Most injuries were mild (94.6%, ISS < 9) and were mainly external wounds (89.2%) and upper and lower limb injuries (35.5%). There was no difference in ISS in terms of the device used (motorised vs. non-motorised). More severe injuries (ISS ≥ 9) were caused by e-bikes (42.9%) and electric scooters (28.6%). Factors associated with these injuries were older age, use of e-bikes, and injuries to the head, face and thorax. Most patients (86.1%) were discharged and one died. CONCLUSION: While most injuries associated with PMDs and e-bikes are minor, serious injuries could result from their use. The SNTR should be updated to include PMDs and e-bikes as a category.

Evaluation of a pilot programme on diagnostic thoracic ultrasound curriculum for acute care physiotherapists.

INTRODUCTION/PURPOSE: Diagnostic thoracic ultrasound is increasingly being used by non-physicians; hence, we evaluated a curriculum for acute care physiotherapists in critical care. METHODS: The one-day course included didactic lectures combined with expert-led hands-on training. Participants undertook pre- and post-course knowledge questionnaire covering key ultrasound findings for normal lungs, pleural and pulmonary pathologies. Course participants who worked at the institution where the course was undertaken undertook a practical examination. We also did a 4- to 6-week follow-up survey of participants. The pretest and post-test questionnaire and survey results were reported using descriptive statistics (means SD or median and IQR). RESULTS: A total of 12 acute care physiotherapists undertook the training and questionnaire scores (mean percentage, SD, 95% CI) increased from 73.3 ± 15.5% (63.4-83.2) before the training to 86.3 ± 5.5% (82.8-89.8) after training. DISCUSSION: This diagnostic thoracic ultrasound training course resulted in improvements of diagnostic thoracic ultrasound knowledge including lung and pleural pathology image recognition skills in a small group of acute care physiotherapists with nil previous diagnostic thoracic ultrasound skills. Two-thirds of the participants who responded to the survey undertook only one to three scans in clinical practice, and the most frequent barrier to clinical use of diagnostic thoracic ultrasound was time constraints. CONCLUSION: Further investigation of such a diagnostic thoracic ultrasound training programme on knowledge and skills retention and image acquisition and interpretation in real life clinical practice in a larger group of acute care physiotherapists is warranted.

SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department.

OBJECTIVE: This study was conducted to evaluate a problem-oriented focused torso bedside ultrasound protocol termed "Sonographic Evaluation of Aetiology for Respiratory difficulty, Chest pain, and/or Hypotension" (SEARCH 8Es) for its ability to narrow differential diagnoses and increase physicians' diagnostic confidence, and its diagnostic accuracy, for patients presenting with dyspnea, chest pain, or symptomatic hypotension. METHODS: This single-center prospective observational study was conducted over 12 months in an emergency department and included 308 patients (184 men and 124 women; mean age, 67.7 ± 19.1 years) with emergent cardiopulmonary symptoms. The paired t-test was used to compare the number of differential diagnoses and physician's level of confidence before and after SEARCH 8Es. The overall accuracy of the SEARCH 8Es protocol in differentiating 13 diagnostic entities was evaluated based on concordance (kappa coefficient) with the diagnosis made by the inpatient specialists. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: SEARCH 8Es narrows the number of differential diagnoses (2.5 ± 1.5 vs. 1.4 ± 0.7; p < 0.001) and improves physicians' diagnostic confidence (2.8 ± 0.8 vs. 4.3 ± 0.9; p < 0.001) significantly. The overall kappa coefficient value was 0.870 (p < 0.001), with the overall sensitivity, specificity, positive predictive value, and negative predictive value at 90.9%, 99.0%, 89.7%, and 99.0%, respectively. CONCLUSION: The SEARCH 8Es protocol helps emergency physicians to narrow the differential diagnoses, increase diagnostic confidence and provide accurate assessment of patients with dyspnea, chest pain, or symptomatic hypotension.

Clinically integrated multi-organ point-of-care ultrasound for undifferentiated respiratory difficulty, chest pain, or shock: a critical analytic review.

Rapid and accurate diagnosis and treatment are paramount in the management of the critically ill. Critical care ultrasound has been widely used as an adjunct to standard clinical examination, an invaluable extension of physical examination to guide clinical decision-making at bedside. Recently, there is growing interest in the use of multi-organ point-of-care ultrasound (MOPOCUS) for the management of the critically ill, especially in the early phase of resuscitation. This article will review the role and utility of symptom-based and sign-oriented MOPOCUS in patients with undifferentiated respiratory difficulty, chest pain, or shock and how it can be performed in a timely, effective, and efficient manner.