Emergency Medicine International最新文献

Study hypothesis: The researchers compared average intubation times between four different devices and hypothesized that a novel laryngoscope based on an enhancement of the rigid anterior commissure laryngoscope would produce faster times to intubation compared to a Macintosh blade with a bougie among inexperienced users on the difficult airway simulation.

Methods: Participants were stratified into novice, intermediate, and advanced skill levels. Each group first performed intubation on a manikin airway without modifications ("easy" airway)-using each of four devices (novel laryngoscope, Macintosh alone, Macintosh with bougie, and GlideScope) in random order-followed by the same technique on a manikin with modifications to mimic a "difficult" airway. Devices requiring the use of a bougie utilize a Seldinger technique. The primary outcome measure was the time taken to inflate the manikin's lungs with the bag ventilator.

Results: Ninety-eight participants were recruited and grouped according to their self-reported experience level: 41 novices, 39 intermediate, and 18 experts. The novel laryngoscope with gum elastic bougie (GEB) led to quicker intubation times (mean 32.0 s) compared with the Macintosh with GEB (mean 37.5 s) among the novice and intermediate groups on the difficult airway (p < 0.05). The methods that utilized a bougie (Macintosh blade with a GEB and Novel Laryngoscope with GEB) led to slower intubation times than the methods not utilizing a bougie (Macintosh blade and GlideScope).

Conclusions: In summary, the Seldinger technique is an important skill for those who perform endotracheal intubations (ETIs), even infrequently or in nonideal settings. The novel laryngoscope may be a helpful option to attain ETI with the reliability of the Seldinger technique and a consistently short ETI interval.

Objective: This study aimed to investigate the predictive value of the Systemic-Immune Inflammation Index (SII) and lipoprotein-associated phospholipase A2 (Lp-PLA2) in the early detection of glufosinate ammonium (GA) poisoning-induced neurotoxicity.

Methods: A retrospective case-control analysis of patients with acute oral GA poisoning was conducted from January 2021 to August 2024. GA poisoning patients who developed neurotoxicity were identified as the case group. The control group was matched 1:2 with the case group on the year of age interval in GA patients without neurotoxicity. Univariate and multiple logistic regression analyses were performed to explore the independent risk of neurotoxicity induced by GA poisoning. Receiver operator characteristic (ROC) curve and area under the curve (AUC) were performed to evaluate the predictive value of SII, Lp-PLA2, and combination of both in GA poisoning patients associated with neurotoxicity.

Results: A cohort of 82 patients experiencing neurotoxicity due to GA poisoning was identified, alongside a control group of 164 individuals who did not exhibit neurotoxic symptoms. The levels of SII and Lp-PLA2 were higher among the case group compared with the control group. After controlling for plasma GA concentration, lactate, neutrophil-to-lymphocyte ratio, and serum ammonia, the results of the multiple logistic regression analysis indicated that the case group was more likely to exhibit elevated levels of the SII (OR = 1.010, 95% CI: 1.004, 1.015, p < 0.001) and Lp-PLA2 (OR = 1.049, 95% CI: 1.032, 1.065, p < 0.001). Furthermore, the areas under the ROC curve of SII, Lp-PLA2, and combination of both were 0.781 (95% CI: 0.717, 0.845, p < 0.001), 0.880 (95% CI: 0.838, 0.923, p < 0.001), and 0.931 (95% CI: 0.901, 0.961, p < 0.001), respectively.

Conclusions: The study concluded that SII, Lp-PLA2, and their combination could serve as predictive biomarkers for assessing the neurotoxicity associated with glufosinate ammonium poisoning.

Background: Hydroxocobalamin is the first-line treatment for confirmed cyanide poisoning. Its empiric use in patients with smoke inhalation injury-where cyanide toxicity is often suspected but not confirmed-remains controversial. Further research is needed to fully understand the benefits and risks associated with its use. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to provide a systematic review of the use of hydroxocobalamin for the treatment of cyanide poisoning secondary to smoke inhalation injury, with a particular focus on mortality and adverse reactions.

Methods: A systematic search of the Cochrane Library, PubMed, and Embase was conducted for studies on cyanide poisoning from smoke inhalation injury treated with hydroxocobalamin. The search was limited to studies from the inception of the journals until July 30, 2025. The quality of the studies was assessed using the Newcastle-Ottawa Scale.

Results: Six studies, comprising a total of 1238 patients, were identified as meeting the inclusion criteria; however, they did not meet the quality threshold for meta-analysis. Thus, only a systematic review was performed. Two studies reported mortality rates, which were found to be similar between the hydroxocobalamin and supportive treatment groups. In contrast, two studies indicated an association between hydroxocobalamin and acute kidney injury, whereas one study proposed a potential correlation with methemoglobinemia.

Conclusions: In light of the uncertain benefits and potential risks associated with hydroxocobalamin use for cyanide poisoning from smoke inhalation injury, its administration should be approached with caution. Well-designed randomized controlled trials are urgently needed to establish optimal treatment strategies for this patient population.

Introduction: Emergency department (ED) revisits are considered a significant indicator of the quality of care provided and are used as a benchmark for the performance of individual providers and institutions. The aim of this study is to assess ED revisit rates, reasons, and hospital admission rates among our adult ED patients.

Methods: This is a retrospective chart review study conducted in a single-center tertiary referral hospital in Riyadh, Saudi Arabia. Study participants comprised adult patients who attended the ED, had been discharged, and had an ED revisit within 72 h from April 2019 to January 2020.

Results: A total of 573 patients met our inclusion criteria, of whom 53.1% were males. The majority of the patients (74.5%) revisiting the ED were categorized as CTAS Level 3, with gastrointestinal complaints being the most common presentation for revisits (23.6%). During the second visit, 94%, 4%, 0.7%, and 0.3% of the participants were discharged, admitted, discharged against medical advice, and died, respectively. Disease progression was the most common cause of revisits at 96.5%. The factors that showed statistically significant associations with nondischarge disposition in the second visit were CTAS levels in the first and second visits, dementia, functional dependency, and reason for the revisit.

Conclusion: Most ED visits within 72 h are due to disease progression rather than system- or physician-related issues, and the majority of these patients are safely discharged after the second visit. Identification of high-risk patients-such as those with higher CTAS levels, dementia, or functional dependency-may aid emergency physicians in implementing targeted discharge planning and coordinated outpatient follow-up to reduce unnecessary revisits and optimize use of emergency services. Our findings highlight the importance of structured post-discharge support and underscore the need for tailored interventions in resource-limited healthcare settings.

Acute pesticide poisoning is a significant public health issue, particularly in low- and middle-income countries where pesticides are commonly used in agriculture. While the neurological and cardiovascular effects of pesticide poisoning have been extensively studied, gastrointestinal injuries remain underexplored despite their severe complications, including bleeding, perforation, and obstruction. This mini-review examines the prevalence, mechanisms, and treatment of gastrointestinal injuries caused by acute pesticide poisoning from 2014 to 2024. Based on an analysis of 11 studies encompassing 38 cases across China, India, and Japan, we identified organophosphate compounds as the most common culprits of gastrointestinal damage. Mechanisms of injury involve multifactorial mechanisms, including the direct toxicity of pesticides, adverse therapeutic interventions such as atropine and gastric lavage, and systemic effects like endothelial dysfunction and hypoxia. Preventive strategies are discussed, including the use of proton pump inhibitors, careful atropine dosing, and balloon jejunal catheter placement to minimize complications. This review underscores the urgent need for further research to develop targeted preventive and therapeutic measures for gastrointestinal injuries caused by pesticide poisoning, aiming to improve patient survival and quality of life.

Background and objectives: Diagnosis of multisystem inflammatory syndrome in children (MIS-C) is challenging due to symptom overlap with other common conditions. The primary objective of this multicenter study was to establish normative laboratory values in MIS-C patients and compare to patients evaluated for MIS-C who had other final diagnoses.

Methods: Five hospitals reviewed records of a cohort of patients 6 months to 18 years old who were evaluated for MIS-C between March 31^st 2020 and February 1^st 2022. Patient demographics, clinical presentation, and laboratory values were compared in patients with a final diagnosis of MIS-C versus all other conditions. Patients' final diagnoses and laboratory values for each diagnosis were reported.

Results: Of the 1319 patients that were evaluated for MIS-C at presentation, 293 (22.2%) received a final diagnosis of MIS-C. MIS-C patients had statistically significant differences in laboratory values including D-dimer, ferritin, fibrinogen, troponin, and brain natriuretic peptide when compared to patients evaluated for MIS-C but subsequently diagnosed with other conditions. The most common non-MIS-C diagnoses within this cohort were viral illnesses (26.7%), acute COVID-19 (12.0%), pyelonephritis (6.4%), fever of unknown origin (4.9%), pneumonia (4.7%), gastroenteritis (4.7%), Kawasaki disease (3.7%), other bacterial infections, (3.1%), rheumatologic conditions (3.1%), and sepsis (2.8%).

Conclusions: Many patients who underwent laboratory evaluation for MIS-C during the COVID-19 pandemic received a final diagnosis other than MIS-C. These data may aid pediatricians in differentiating between MIS-C and other febrile conditions as well as reduce unnecessary testing.

Objective: To evaluate the surgical outcomes of microsurgical treatment and transarterial endovascular embolization for dural arteriovenous fistulas (DAVFs).

Methods: A retrospective analysis was conducted on 47 patients diagnosed with high-grade DAVFs (Cognard types 2b, 2a + b, 3, 4, and 5) between June 2019 and June 2022 at Nanjing Brain Hospital, affiliated with Nanjing Medical University. These patients underwent either microsurgery or endovascular embolization. Postoperative efficacy, surgical complications, and related prognostic factors were compared between the two groups. The primary endpoint was a postoperative modified Rankin Scale (mRS) score > 3. Secondary outcomes included angiographic confirmation of fistula occlusion, complication rates, and neurological deficits.

Results: In the microsurgical treatment group, complete fistula occlusion was achieved in 23 patients (85.185%), while 12 patients (60.000%) in the transarterial embolization group (single-session treatment) achieved complete occlusion. Although microsurgical treatment demonstrated a higher occlusion rate, this difference did not reach statistical significance (p=0.051). The median follow-up duration for all patients was 12 months (IQR 1-38 months). During follow-up, 2 patients (4.255%) with residual untreated fistulas developed severe neurological deficits. In contrast, none of the patients with single fistulas developed severe postoperative complications.

Conclusion: Microsurgical treatment demonstrated a higher rate of complete fistula occlusion compared to single-session transarterial embolization in patients with DAVFs, although this difference was not statistically significant. Both treatment modalities showed acceptable safety profiles. Patients with single fistulas showed a lower risk of severe postoperative neurological deficits compared to those with multiple fistulas. This study provides important insights into the emergency treatment of DAVF.

Trial registration: Chinese Registry of Clinical Trials: ChiCTR2300072890.

Purpose: To differentiate complicated appendicitis (CA) from uncomplicated appendicitis (UA) in children, we developed and validated an artificial intelligence (AI) model using a multimodal approach integrating ultrasound images and clinical data.

Methods: A retrospective analysis was performed on 372 pathologically confirmed pediatric appendicitis cases (230 male, 142 female) from three centers, all with preoperative abdominal ultrasound. Deep learning (DL) features and radiomic features were extracted from appendiceal ultrasound images using deep transfer learning (DTL) and conventional radiomic methods, respectively. We selected 12 radiomic features, 9 DL features, and 3 clinical features-namely, white blood cell count (WBC), neutrophil count (NEU), and C-reactive protein (CRP)-for building the machine learning classification model. Based on these features, four distinct models were constructed: the Rad model (radiomic features only), the DL model (DL features only), the DTL model (combined radiomic and DL features), and the Combine model (integrating all three feature types: radiomic, DL, and clinical features). Model performance was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and the DeLong test. Finally, the combined model was compared to the performance of clinicians with varying levels of experience.

Results: The combined model demonstrated consistently favorable performance across all cohorts (AUC: 0.940, 0.895, 0.866, and 0.783 for training and validation sets, respectively). The model's accuracy (0.862) and positive predictive value (0.896) were comparable to senior surgeons (0.741, 0.970) and superior to junior surgeons (0.672, 0.865) in the internal validation cohort. DCA confirmed the clinical utility of the combined model over conventional strategies.

Conclusion: Our ultrasound-based AI model provides reliable differentiation between CA and UA in children, offering potential value as a diagnostic support tool for clinical decision making.

Background: Acute coronary syndrome (ACS) poses a significant burden worldwide; however, the development of high-sensitivity cardiac troponin (hs-cTn) assays has greatly improved patient management by enabling the detection of very low levels of troponin. The objective of this review was to identify current hs-cTn point-of-care (POC) assays, describe their key features, and discuss their analytical and clinical performance.

Methods: PubMed, MEDLINE, and Embase databases, as well as relevant web sources, were searched for publications up to April 10, 2025. The references included describe the main characteristics of POC hs-cTn assays and their companion instruments, as well as studies assessing their analytical or clinical performance in the context of acute myocardial infarction diagnosis.

Results: In addition to information publicly available from the web, 27 publications were considered relevant for this review. From the retrieved sources, seven POC hs-cTn assays were identified as currently cleared by the United States Food and Drug Administration or CE-marked. Four additional POC hs-cTn assays, each evaluated for analytical or clinical performance, were identified as currently or previously under development. POC instruments differ in their key characteristics, many of which are crucial for ensuring their suitability in specific clinical settings and intended applications. Despite some variability in performance across different platforms, they are generally consistent with the high-sensitivity profile expected of cTn assays. Clinical performance indicators for hs-cTn assays align with European Society of Cardiology (ESC) recommendations, particularly when ESC-recommended diagnostic algorithms are applied. Reported sensitivity and negative predictive values exceed 99%, while positive predictive values are above 70%. Moreover, comparative studies of POC hs-cTn assays and laboratory-based hs-cTn tests have demonstrated no significant differences in diagnostic accuracy for ruling in or ruling out acute myocardial infarction.

Conclusion: POC hs-cTn assays represent a promising alternative to traditional laboratory testing, providing similar analytical and clinical performance while enabling faster diagnosis and management of ACS. Expanded use of hs-cTn assays in clinical practice could transform patient care pathways, especially in time-critical situations. Continued research and ongoing technological advancements are critical to ensure optimal use and widespread adoption in routine clinical settings.

Introduction: Gastrointestinal system (GIS) bleeding is one of the most common reasons for emergency department visits. The aim of this study is to investigate the impact of base excess, lactate, and alactic base excess-parameters that can be quickly assessed through blood gas analysis-on predicting the clinical outcome in patients presenting to the emergency department with GIS bleeding.

Materials and methods: The study was retrospective and conducted at a single center from January 1 to December 31, 2022. The collected data included age, gender, blood gas (lactate and base excess), and outcomes (discharge, intensive care, and death).

Results and conclusions: The study included 205 patients (135 males and 70 females). Deceased individuals had a lower average base excess and higher lactate levels. There were no significant differences in ward admission based on alactic base excess status. A base excess cutoff value of ≥ -0.65 was used to predict ward admission, yielding a sensitivity of 57.71%, specificity of 63.33%, PPV of 90.18%, and negative predictive value of 20.43%. According to the data obtained in our study, we observed that a lactate cutoff value ≥ 2.07 could be effective in predicting ICU admission for patients. We also found that a base excess cutoff value ≥ -0.65 could be effective in predicting admission to the ward. The mean base excess was lower in patients who resulted in death compared to survivors, while the mean lactate level was higher. However, no significant result was found regarding alactic base excess.