Background: The shock index (SI) predicts short-term mortality in trauma patients. Other shock indices have been developed to improve discriminant accuracy. The authors examined the discriminant ability of the SI, modified SI (MSI), and reverse SI multiplied by the Glasgow Coma Scale (rSIG) on short-term mortality and functional outcomes. Methods: The authors evaluated a cohort of adult trauma patients transported to emergency departments. The first vital signs were used to calculate the SI, MSI, and rSIG. The areas under the receiver operating characteristic curves and test results were used to compare the discriminant performance of the indices on short-term mortality and poor functional outcomes. A subgroup analysis of geriatric patients with traumatic brain injury, penetrating injury, and nonpenetrating injury was performed. Results: A total of 105 641 patients (49±20 years, 62% male) met the inclusion criteria. The rSIG had the highest areas under the receiver operating characteristic curve for short-term mortality (0.800, CI: 0.791–0.809) and poor functional outcome (0.596, CI: 0.590–0.602). The cutoff for rSIG was 18 for short-term mortality and poor functional outcomes with sensitivities of 0.668 and 0.371 and specificities of 0.805 and 0.813, respectively. The positive predictive values were 9.57% and 22.31%, and the negative predictive values were 98.74% and 89.97%. rSIG also had better discriminant ability in geriatrics, traumatic brain injury, and nonpenetrating injury. Conclusion: The rSIG with a cutoff of 18 was accurate for short-term mortality in Asian adult trauma patients. Moreover, rSIG discriminates poor functional outcomes better than the commonly used SI and MSI.

Early surgical intervention in hip fractures is associated with lower complications. This study aimed to determine the appropriate operation time among Asian geriatric patients. The data of 1118 elderly patients with hip fracture at Mackay Memorial Hospital from 1 January 2011, to 31 July 2019, were retrospectively examined. Association between operation waiting time and the occurrence of complications was calculated using a cubic spline model. Significantly increased incidence of pneumonia, myocardial infarction, and heart failure was observed in 30 and 90 days when the patient’s surgical waiting time exceeded 36 h. The incidence rates of pneumonia across the early and delayed groups within 30 and 90 days were 4.4% vs. 7.9%, and 6.2% vs. 10.7%, those of myocardial infarction were 3.0% vs. 7.2%, and 5.7% vs. 9.3%, and those of heart failure were 15.2% vs. 26.8%, and 16.2% vs. 28.5%. Deep vein thrombosis and pulmonary embolism were not associated with surgical delay. The overall 30-day mortality rate was 5.4%, and no significant difference was observed when the surgical waiting time exceeded 36 h. In summary, operation waiting time exceeding 36-h was associated with increased rates of pneumonia, myocardial infarction, and heart failure in Asian geriatric patients undergoing hip fracture surgery.

Coronavirus disease 2019 (COVID-19) remains a global pandemic. Early warning scores (EWS) are used to identify potential clinical deterioration, and this study evaluated the ability of the Rapid Emergency Medicine score (REMS), National Early Warning Score (NEWS), and Modified EWS (MEWS) to predict in-hospital mortality in COVID-19 patients. This study retrospectively analyzed data from COVID-19 patients who presented to the emergency department and were hospitalized between 1 May and 31 July 2021. The area under curve (AUC) was calculated to compare predictive performance of the three EWS. Data from 306 COVID-19 patients (61 ± 15 years, 53% male) were included for analysis. REMS had the highest AUC for in-hospital mortality (AUC: 0.773, 95% CI: 0.69–0.85), followed by NEWS (AUC: 0.730, 95% CI: 0.64–0.82) and MEWS (AUC: 0.695, 95% CI: 0.60–0.79). The optimal cut-off value for REMS was 6.5 (sensitivity: 71.4%; specificity: 76.3%), with positive and negative predictive values of 27.9% and 95.4%, respectively. Computing REMS for COVID-19 patients who present to the emergency department can help identify those at risk of in-hospital mortality and facilitate early intervention, which can lead to better patient outcomes.

The coronavirus disease 2019 (COVID-19) has become a global pandemic since March 2020 and caused healthcare insufficient resources, economic and political issues. Taiwan was one of the few successful countries to contain the vicious virus without community spread. Since the Severe Acute Respiratory Syndrome (SARS) outbreak in 2013, quarantine wards have been proposed for controlling the possible highly contagious disease. In the COVID-19 era, MacKay Memorial Hospital in Taiwan had been operating quarantine rooms since April 2020. Patients who needed hospitalization for fever, COVID-like symptoms, or pneumonia were admitted to quarantine rooms while waiting for the result of the COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) test. We implemented a well-established quarantine policy without visitors allowed during the patient's quarantine period. Healthcare workers must self-report fever or COVID-like symptoms every day. We started the release evaluation from quarantine after receiving the negative result of COVID-19 RT-PCR. Infection disease (ID) physicians were in charge of the release process. If a patient continued to have any persistent COVID-like symptoms or uncontrolled pneumonia, ID physicians would not grant the release from quarantine. Since the establishment of the quarantine rooms, over one thousand suspected COVID-19 patients had been admitted. There has been no community transmitted cases reported for more than 200 days as of the end of November 2020 in Taiwan. Good practice of preventive measures like our operation of quarantine wards is early and vital planning of the hospital strategy against the spread of COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus that causes a disease named coronavirus disease 2019 (COVID-19), and it was announced as a public health emergency of international concern by the World Health Organization on January 30th, 2020. Until July 2020, there are 216 countries with reported COVID-19 cases, and over 13 million confirmed cases globally. During the pandemic of COVID-19, there are currently several different strategies among the world for screening and controlling the transmission of COVID-19, including diagnostic testing stations outside the hospital, and triage stations in hospitals and emergency departments. According to current evidence, there is not a single criteria or strategy that can fit the demand of every country or hospital. Strategy can vary largely due to different geographic locations and different pandemic progressing status of every hospital, and island countries may require a totally different approach compared with continental countries. In this article, we reviewed different strategies and approaches in reaction to the COVID-19 pandemic, and we shared our experience as a medical center in Taiwan. In conclusion, every hospital should develop their own pandemic-reacting response plan, and the plan should be flexible and adjust according to the rapidly changing pandemic situation.

To the Editor,The prompt recognition of COVID-19 infected patients is essential to control the COVID-19 pandemic. The reverse transcriptase-polymerase chain reaction (RT-PCR) test is the gold stand...