Emergency Medicine International最新文献

Since 1989, the definition of sepsis has been revised several times. The 2016 Sepsis-3 consensus definition of sepsis aims to improve diagnostic accuracy and reduce the frequency of misdiagnosis. The Sequential Organ Failure Assessment (SOFA) scoring system facilitates personalized treatment. Sepsis-related biomarkers are essential for diagnosis, treatment, and prognosis; however, their widespread application is limited by their insufficient sensitivity and specificity. From October 2019 to October 2024, 4801 studies had reported on sepsis-related biomarkers. The number of studies initially increased but subsequently decreased over time (beginning from 2021). C-reactive protein (CRP) and procalcitonin (PCT) are the most frequently investigated biomarkers, and their combination with other biomarkers can improve diagnostic accuracy. Advancements in data-driven technologies have helped optimize the definition of sepsis, accelerate early diagnosis, clarify subphenotypes, improve prognostic assessment, and develop personalized treatment strategies. With the deepening of research on the pathological mechanisms of sepsis, novel biomarkers such as vascular endothelin, vasoactive peptides, BMP9, cytokines, chemokines, and cfDNA have emerged, which are closely related to the severity of the disease. The clinical application of known biomarkers has expanded, and their kinetic changes are considered more accurate than a single value in predicting outcomes. In addition, related studies have focused on the exploration of precision medicine for sepsis. Efforts have been made to divide patients into more homogeneous subgroups by distinguishing their shared biological characteristics, thus providing valuable avenues for developing novel therapeutic approaches. This article reviews the research status of some commonly used sepsis biomarkers from October 2019 to October 2024, analyzes the current application status and limitations, pays attention to the changes of biomarkers and the exploration of precision medicine for sepsis, and aims to develop new treatment approaches by dividing patients into subgroups.

Purpose: This study aimed to evaluate the safety and efficacy of transcatheter arterial embolization (TAE) for hemorrhage control in patients with traumatic liver injury complicated by celiac axis stenosis (CAS). Methods: Nine patients diagnosed with CAS who underwent TAE between January 2012 and December 2024 were included in this retrospective study. Imaging studies were used to assess the vascular anatomy, and clinical outcomes were analyzed, focusing on technical and clinical success rates and complications. Results: All patients achieved technical success with TAE, with a clinical success rate of 77%, and no 30-day mortality. Seven patients had medial arcuate ligament compression, which was identified as the cause of CAS, while two patients had atherosclerosis. Conclusion: TAE is a safe and effective intervention for managing hemorrhage in traumatic liver injury complicated by CAS. Thorough assessment of computed tomography images is crucial for diagnosing the underlying causes of CAS and optimizing catheterization strategies.

Background: Acute abdominal pain (AAP) is a common complaint of emergency department patients. An accurate diagnosis is even more crucial when AAP is associated with left lower quadrant (LLQ) pain, which has a wide variety of differential diagnoses from self-limiting to life-threatening diseases. This study aimed to evaluate the diagnostic efficacies of physical examination (PE), plain abdominal radiography (PAR), and ultrasonography (US) compared to the computed tomography (CT) scan in patients with nontraumatic LLQ AAP coming into the emergency department. Methods: This prospective cross-sectional study was performed on 220 patients with LLQ-AAP for > 2 h and < 5 days who underwent PAR, US, and CT after PE. An expert surgeon assigned a final diagnosis. Test characteristics, including diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative PV (NPV), were calculated for PE, PAR, and US, using a CT scan as the gold standard. Results: Among 220 patients (mean age of 48.17; 55.5% female), PE, PAR, and US yielded an overall accuracy of 30.91%, 35.91%, 50.91%, sensitivity of 75.47%, 62.26%, 39.62%, specificity of 16.77%, 27.54%, 54.49%, PPV of 22.35%, 21.43%, 21.65%, and NPV of 68.29%, 69.70%, and 73.98%, respectively. Conclusions: As a result of the highest sensitivity for PE and the highest accuracy for the US, we suggest considering PE as the primary investigation for identifying urgent conditions in patients with LLQ AAP and the US for an accurate diagnosis rather than PAR.

Background and Purpose: Previous studies have demonstrated that the shock index (SI), age-adjusted shock index (ASI), and modified shock index (MSI) are useful for predicting massive transfusion (MT) and mortality in patients with traumatic injuries. However, studies have not been conducted on the use of the age-modified shock index (AMSI) to indicate the prognosis of patients with traumatic injuries. This study aimed to evaluate the predictive power of AMSI for MT and mortality. We hypothesized that AMSI would be superior to other indices in predicting outcomes in patients with traumatic injuries. Methods: This retrospective, single-center study was conducted at a level 1 trauma center and included consecutive patients who visited the trauma center between January 2016 and December 2022. The predictive value of AMSI for MT, in-hospital mortality, and 24 h mortality was assessed using receiver operating characteristic (ROC) analysis. We compared the area under the ROC curve (AUROC) of AMSI with those of SI, ASI, and MSI. Results: In total, 6591 patients were included in the study, of whom 479 received MT. The in-hospital and 24 h mortality rates were 8.7% and 5.3%, respectively. The SI, ASI, MSI, and AMSI all showed better predictive performance for MT (AUC > 0.7) than that for in-hospital (AUC: 0.50, 0.61, 0.50, and 0.62) and 24 h mortality (AUC: 0.54, 0.56, 0.54, and 0.56). However, AMSI did not demonstrate superior performance compared with the other indices (SI, ASI, and MSI) in predicting both MT and 24 h mortality. AMSI demonstrated significantly better predictive performance for in-hospital mortality than the other indices; however, the difference from ASI was not substantial. This is likely because age has a significant impact on in-hospital mortality. Conclusion: Indices other than AMSI that are easier to compute may be more useful for the prognostic evaluation of patients with traumatic injuries.

Background: Hymenoptera stings are a common cause of emergency visits. Objective: This study aims to assess potential gender disparities in clinical presentation and outcomes of Hymenoptera stings. Methods: Medical records were collected from a single medical center in Northern Taiwan, covering the period from April 1, 2021, to March 31, 2023. A total of 87 patients with confirmed Hymenoptera sting incidents were identified. Data on gender, sting location, clinical presentation, diagnostic evaluation, complications, treatment, and clinical outcomes were analyzed. Results: Among the 87 patients, 47.1% were male and 52.9% were female, showing a nearly balanced distribution of cases. Females experienced a higher rate of stings during holidays. Males, however, were more likely to suffer from severe systemic reactions and had a higher average number of stings compared to females (1.3 vs. 1.0, p=0.049). Conclusion: Males are at higher risk for multiple stings and severe systemic reactions from Hymenoptera stings. Additionally, females tend to experience more stings during spring and autumn compared to males.

Background: The influence of prepregnancy body mass index (BMI) and dietary patterns on pregnancy outcomes remains unclear. This study examines the sociodemographic factors affecting the prepregnancy BMI and dietary health, as well as their impact on maternal and neonatal complications. Methods: A total of 1064 women were enrolled at the Jinan Maternal and Child Health Hospital (Shandong, China) from January 2021 to December 2023. The China pregnancy healthy diet index (CHDI-P) was used to assess dietary health. Regression analyses were conducted to evaluate the relationship between sociodemographic characteristics, the BMI, CHDI-P scores, and adverse pregnancy outcomes. Results: Higher education and moderate income were protective factors for maintaining a normal BMI, while older maternal age was linked to dietary patterns. Prepregnancy obesity significantly increased the risk of gestational diabetes and hypertension, while overweight and obesity were associated with a lower risk of small-for-gestational-age (SGA) births. Additionally, suboptimal dietary patterns were linked to a higher risk of large-for-gestational-age (LGA) infants and macrosomia. Conclusion: Prepregnancy overweight, obesity, and unhealthy dietary patterns contribute to adverse pregnancy outcomes, including gestational diabetes, hypertension, LGA, and macrosomia. These findings highlight the importance of weight management and nutritional guidance before and during pregnancy, particularly for women with lower educational attainment.

Background: Among patients with trauma, those with self-harm exhibit different characteristics than those who experience general accidents. Unstable vital signs following a severe injury often limit accurate imaging and injury assessment during initial treatment, rendering decision-making challenging for definitive care. Identifying correlations between damage area and severity can improve predictions and treatment decisions. We identify differences in characteristics of trauma between patients who experienced general accidents and those who attempted suicide. Methods: This study investigates differences in trauma characteristics between accidental and self-harm injuries in a single-center cohort of 10,180 patients (2015-2023). We analyzed age, sex, trauma mechanism, intention of suicide, Abbreviated Injury Scale (AIS) score, injury severity score (ISS), and height for falls. We divided intentionality into accident and self-harm and analyzed and compared their characteristics. Results: The self-harm group was significantly younger (mean: 10 years younger, p < 0.05) and had a higher proportion of falls (41.0%) and stab injuries (48.9%). Self-harm falls were more severe, with a mean fall height of 10.8m (vs. 4.14m in the accidental group, p < 0.001), resulting in a higher ISS (18.6 vs. 15.5, p < 0.05). In the self-harm group, fall attempts were common among teenagers and those in their 20s, while knife injuries were common in individuals in their 40s and 50s. Conclusion: This study confirmed the relationship between the injury mechanism and AIS in patients with trauma. The damaged area and degree of damage differed between the self-harm and accident groups, even with the same mechanism. Understanding these patterns can enhance initial ER assessments and reduce missed injuries in high-risk patients.

Objective: Chest pain is a common complaint in emergency departments. Although most patients are admitted to emergency department intensive care, only 12% have acute coronary syndrome. An accurate, efficient score is needed to improve triage and prevent unnecessary referrals to emergency department intensive care. The Marburg Heart Score, validated to rule out acute coronary syndrome in primary care, is quick to administer and does not require test results. This study aims to assess whether the Marburg Heart Score is effective in a triage setting for patients presenting with chest pain in emergency departments. Method: This prospective, observational, multicenter study was conducted with triage nurses in four hospitals in France between July 15, 2018, and May 31, 2019. The primary endpoint was the negative predictive value of the Marburg Heart Score ≤ 2 for ruling out acute coronary syndrome. Acute coronary syndrome diagnosis was made using medical record data combined with a diagnosis from the physician in charge. Results: A total of 1045 patients were included. For a cutoff score of ≤ 2, the negative predictive value for suspected acute coronary syndrome was 95.6% (95% CI [94.0-97.2]) and the area under the curve was 0.603 (95% CI [0.521-0.685]). There were 28 false negatives, two of which were due to the score being completed incorrectly. Conclusion: This study reveals that the Marburg Heart Score is an efficient tool to direct patients presenting with chest pain and MHS < 2 to a conventional ED bed. This could potentially optimize triage in the emergency department to prevent overloading the emergency department intensive care.

Background: Sepsis is a common and serious condition, where mitochondria and macrophage polarization play a crucial role. Therefore, this study aimed to identify and validate biomarkers for sepsis associated with mitochondria-related genes (MCRGs) and macrophage polarization-related genes (MPRGs), providing new targets and strategies for therapeutic intervention. Methods: This study utilized the GSE95233 and GSE28750 datasets. Initially, intersection genes were identified by overlapping MCRGs and the results from differential expression analysis and weighted gene co-expression network analysis (WGCNA). Biomarkers were identified through machine learning and gene expression analysis. A nomogram was developed and evaluated based on these biomarkers. Finally, functional enrichment, immune infiltration, and reverse transcription quantitative polymerase chain reaction (RT-qPCR) analyses were conducted to further elucidate the biological mechanisms underlying sepsis. Results: The study identified YME1L1, ECHDC3, THEM4, and COQ10A as biomarkers for sepsis. Among them, YME1L1, THEM4, and COQ10A showed significantly lower expression levels in sepsis samples, while ECHDC3 exhibited markedly higher expression. Notably, RT-qPCR analysis confirmed that YME1L1, THEM4, and COQ10A exhibited significantly lower expression levels in sepsis samples. A nomogram based on these biomarkers was developed and validated, effectively predicting sepsis risk. Enrichment analysis indicated that the biomarkers were co-enriched in the oxidative phosphorylation pathway. Additionally, 13 significantly different immune cell types were identified between sepsis and control samples. Biomarker association analysis revealed that CD8 T cells had the strongest positive correlation with YME1L1 (cor = 0.84, p < 0.05) and the strongest negative correlation with ECHDC3 (cor = -0.76, p < 0.05), suggesting their potential role in the disease mechanism. Conclusion: In this study, YME1L1, ECHDC3, THEM4, and COQ10A were identified as biomarkers for sepsis, with their expression levels validated in clinical samples. These findings provided a promising theoretical foundation for the development of targeted treatments for sepsis.

Background: Pulmonary embolism (PE) is a clinical condition frequently encountered in the emergency department (ED), with a high and early mortality rate. ED triage determines the priority of further evaluation of care at the time of patient arrival. Very little is known about the specific role of ED triage in PE. We aimed to evaluate (1) whether the current five-level triage (5LT) system can identify patients with PE and differently prioritize them for medical evaluation and (2) the discriminatory capacity of simplified revised Geneva score (SRGS) toward PE diagnosis when calculated by triage nurses. Methods: A retrospective chart review on ED patients who underwent computed tomography pulmonary angiography (CTPA) in 2023. Based on the CTPA report, patients were categorized into two subgroups: CTPA PE-negative and CTPA PE-positive. We then searched for correlations between PE diagnosis and triage priority level, time from triage to medical evaluation, SRGS, and National Early Warning Score 2 (NEWS2). Results: Of the 196 patients included in the analysis (age 71.1 ± 16.9), 45 (23.0%) were CTPA PE-positive (26 proximal PE and 19 distal PE). There was no correlation between the assigned triage color code and the CTPA results. Although we found a statistically significant difference in the prevalence of CTPA-confirmed PE according to the results of the SRGS (p = 0.014), the SRGS calculated at the time of triage showed a poor prediction accuracy for subsequent PE diagnosis (area under curve [AUC] 0.608). NEWS2 was significantly associated with the triage-assigned priority level (p < 0.001). Conclusions: The current 5LT was unable to differently prioritize patients with or without PE, and it seems unlikely that implementation of SRGS in the triage nurse evaluation will significantly improve the prioritization of patients with suspected PE for medical evaluation. Nonetheless, application of SRGS in triage evaluation may improve the appropriateness of the subsequent clinical pathway for PE diagnosis and risk stratification.