Vajira Medical Journal: Journal of Urban Medicine

173-180

Authors: Supakit Chartchaiyarerk, Surapong Sungtra

Objectives: To compare the result of appendicitis treatment between laparoscopic surgery (LA) and open surgery (OA) in overweight patient. In term of hospital length of stay (LOS), intraoperative time, time to resume diet and postoperative complications. Methods: A retrospective study by reviewing medical records of overweight patients (BMI ≥ 23 kg/m2) in Bangkok Metropolitan Administration General Hospital with acute appendicitis who underwent LA and OA from January 2012 through December 2017. The data included personal information, intraoperative details, postoperative details and the data of those was analyzed and was compared between open and laparoscopic surgery. Results: There were 136 (71 male, 65 female) overweight patients underwent appendectomy. Subjects were divided into 2 groups; 68 in LA and 68 in OA. Median length of stay (LOS) for LA was better, 58.5 hours versus 85.5 hours for OA (P < 0.01), median operative blood loss for LA was better, 5 ml versus 20 ml for OA (P < 0.01) and primary wound closure rate was better, 100% for LA versus 85% for OA (P = 0.001). Other outcome measures were equivalent. Conclusion: LA can be performed safely with shorter LOS, less delayed primary wound closure and less operative blood loss in overweight patients and should be considered the procedure of choice for overweight patients with appendicitis.

193-204

Authors: Orain Winthachai, Chirakit Hengrussamee

Introduction: Emergency Medical Services (EMS) in Thailand are considered as multi-tiered response system providing medical care regarding the degrees of emergency and severity prioritization. Thus, effective triage tools are mandatory for efficient resource management to achieve productivity during pre-hospital emergencies and casualties. Objectives: To compare the agreement and consistency in severity assignment between the standard in-hospital emergency severity index (ESI) and the pre-hospital assessment tools, including the phone triage with criteria-based dispatch protocol and the on-scene triage using the National Early Warning Score (NEWS). Methods: This is a retrospective, descriptive study of EMS missions conducted by a single urban EMS center, Vajira Hospital. Data including phone triage medical dispatch codes, pre-hospital NEWS and ESI levels were collected and analyzed. Results: A total of 950 EMS missions were evaluated, among which 93.6% were categorized as ‘red code’. The phone triage medical dispatch demonstrated the over-triage rate of 26.2% and the under-triage rate of only 1.7% with slight reliability (Kappa 0.165; p-value < 0.001) when compared to ESI levels, whereas the pre-hospital NEWS resulted in the under-triage rate of 47.8% with fair reliability (Kappa 0.344; p-value < 0.001). Conclusion: For pre-hospital settings, the phone triage using medical dispatch codes provides more accurate severity assignment with optimal outcomes consistent with the international recommendations, whereas the NEWS seems to generate excessive undertriage rate.

213-222

Authors: Nichanan Boonon; Wongpun Limpaseni

Objectives: To study the physical aspect and convenience of walking and to analyze the behavior, satisfaction and needsof pedestrians inorder to propose ways to improve sidewalks in Bangkok. Methods: This research was a quantitative research coupled with qualitative research using the ADB Pedestrian Preference Survey Form adapted to suit local conditions. The survey was conducted for each of the section from one station to another of the light green sky train line (Silom line) to evaluate convenience of walking (Walkability index) for each section of the sidewalk. Notes, video and notes were taken in order to use the information to analyze for problems and obstacles along the sidewalk. Questionnaire on behavior and satisfaction of pedestrian was conducted on samples without using probability theory (Non-Probability) employing Haphazard or Accidental Sampling of pedestrians on 12 sidewalk sections, 17 samples each section for a total of 204 samples. The questionnaire consists of 2 parts: part 1 is basic information and part 2 is the behavior and satisfaction of pedestrians. The questionnaire was multiple choices and preference ranking. Data were analyzed by frequency distribution percentage. Results: Survey results of walking convenience found obstacles to walking on sidewalk include (1) lack of equipment and facilities for the disabled (ramp, blind block) (2) safety from crime (3) equipment and facilities for pedestrians. Questionnaire on satisfaction of pedestrian have the following results: (1) Ease of walking was low (55.39%) (2) Pedestrian safety was low (58.33%) (3) Improvements needs were safety from crime (street light, CCTV, and risky spots 22.06%), width and surface quality of sidewalk (21.08%). If there is improvement to sidewalk, there would be high preference to use the sidewalks (61.76%) Conclusion: Obstacles that cause walking inconvenience and in line with the preference of pedestrians to improve sidewalks are (1) Lack of equipment and facilities for pedestrians and disabled people (2) Safety from crime (3) Continuation of sidewalk, pedestrian crossing, obstacles to walking and driving on sidewalk. Improvements to the sidewalk will increase number of pedestrians leading to better health of people and help reduce road traffic and pollution in Bangkok.