Patrik Gilje, Moman A. Mohammad, Andreas Roos, Ulf Ekelund, Jonas Björk, Bertil Lindahl, Martin Holzmann, Arash Mokhtari
Background. Ruling out acute myocardial infarction (AMI) in the emergency department (ED) is challenging. Studies have shown that a high-sensitivity cardiac troponin T (hs-cTnT) <5 ng/L or <6 ng/L at presentation (0 h) can be used to rule out AMI. The objective of this study was to identify whether an even higher hs-cTnT threshold can be used for a safe rule out of AMI in the ED. Methods. The derivation cohort consisted of 24,973 ED patients with a primary complaint of chest pain. In this cohort, we identified the highest concentration of 0 h hs-cTnT that corresponded to a negative predictive value (NPV) of ≥99.5% for the primary endpoint of AMI/all-cause death within 30 days and the secondary endpoint of all-cause death within one year. The results were validated in two cohorts consisting of 132,021 and 1167 ED chest pain patients. Results. The 0 h hs-cTnT threshold corresponding to a NPV of ≥99.5% for the primary endpoint was <9 ng/L (NPV: 99.6% and 95% CI: 99.5–99.7). This cutoff provided a sensitivity of 96.2% (95% CI: 95.2–97.1) and identified 59.7% of the patients as low risk compared to 35.8% and 43.9% with a 0 h hs-cTnT <5 ng/L and <6 ng/L, respectively. The results were similar in the validation cohorts and seemed to perform even better in patients where the 0 h hs-cTnT was measured >3 h after symptom onset and in those with a nonischemic ECG and nonhigh risk history. Conclusions. A 0 h hs-cTnT cutoff of <9 ng/L safely rules out AMI/death within 30 days in a majority of chest pain patients and is a more effective strategy than the currently recommended <5 ng/L and <6 ng/L cutoffs. This trial is registered with NCT03421873.
{"title":"A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction","authors":"Patrik Gilje, Moman A. Mohammad, Andreas Roos, Ulf Ekelund, Jonas Björk, Bertil Lindahl, Martin Holzmann, Arash Mokhtari","doi":"10.1155/2024/2241528","DOIUrl":"https://doi.org/10.1155/2024/2241528","url":null,"abstract":"<i>Background</i>. Ruling out acute myocardial infarction (AMI) in the emergency department (ED) is challenging. Studies have shown that a high-sensitivity cardiac troponin T (hs-cTnT) <5 ng/L or <6 ng/L at presentation (0 h) can be used to rule out AMI. The objective of this study was to identify whether an even higher hs-cTnT threshold can be used for a safe rule out of AMI in the ED. <i>Methods</i>. The derivation cohort consisted of 24,973 ED patients with a primary complaint of chest pain. In this cohort, we identified the highest concentration of 0 h hs-cTnT that corresponded to a negative predictive value (NPV) of ≥99.5% for the primary endpoint of AMI/all-cause death within 30 days and the secondary endpoint of all-cause death within one year. The results were validated in two cohorts consisting of 132,021 and 1167 ED chest pain patients. <i>Results</i>. The 0 h hs-cTnT threshold corresponding to a NPV of ≥99.5% for the primary endpoint was <9 ng/L (NPV: 99.6% and 95% CI: 99.5–99.7). This cutoff provided a sensitivity of 96.2% (95% CI: 95.2–97.1) and identified 59.7% of the patients as low risk compared to 35.8% and 43.9% with a 0 h hs-cTnT <5 ng/L and <6 ng/L, respectively. The results were similar in the validation cohorts and seemed to perform even better in patients where the 0 h hs-cTnT was measured >3 h after symptom onset and in those with a nonischemic ECG and nonhigh risk history. <i>Conclusions</i>. A 0 h hs-cTnT cutoff of <9 ng/L safely rules out AMI/death within 30 days in a majority of chest pain patients and is a more effective strategy than the currently recommended <5 ng/L and <6 ng/L cutoffs. This trial is registered with NCT03421873.","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"27 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140301751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahbobeh VatanKhah, Javad Malekzadeh, Mohammad-Davood Sharifi, Amir Mirhaghi
<i>Introduction</i>. The diagnostic evaluation of the emergency severity index (ESI) in the triage of patients with cardiopulmonary complaints has a high sensitivity but a low specificity in the emergency department (ED). Therefore, triage scales with more accurate diagnostic evaluation are required. As a result, accuracy of the SINEH triage scale (SinTS) and the ESI was compared to compare mistriage of critically ill patients with cardiopulmonary complaints. <i>Methods</i>. This descriptive, analytical and cross-sectional study was conducted between December 2022 and April 2023. In this study, two nurses independently examined each patient using two triage scales. The admission unit and length of hospital stay were also recorded. The outcome was classified as high-risk admission (cardiac care unit and intensive care unit) and low-risk admission (internal unit or discharge from the ED). Undertriage and overtiage were defined as high-risk admission with triage level 3 and 4 and low-risk admission with triage level 1 or 2, respectively. A panel of experts evaluated content validity of SinTS and kappa designating agreement on relevance reported. The inter-rater reliability of two scales was also reported. <i>Results</i>. Finally, the study included 145 patients. The average age of the patients studied was 61.35 years. SinTS has a total mistriage of 29.63%, with 4.13% being undertriage and 25.5% being overtriage. In ESI, the total mistriage is 66.8%, with 1.3% being undertriage and 65.5% being overtriage. The undertriage of the two scales did not differ significantly by admission unit (<span><svg height="11.7782pt" style="vertical-align:-3.42938pt" version="1.1" viewbox="-0.0498162 -8.34882 18.973 11.7782" width="18.973pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"></path></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"></path></g></svg><span></span><span><svg height="11.7782pt" style="vertical-align:-3.42938pt" version="1.1" viewbox="22.555183800000002 -8.34882 21.921 11.7782" width="21.921pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,22.605,0)"></path></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"></path></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"></path></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"></path></g></svg>),</span></span> but the overtriage of the two methods did (<span><svg height="11.7782pt" style="vertical-align:-3.42938pt" version="1.1" viewbox="-0.0498162 -8.34882 18.973 11.7782" width="18.973pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"></use></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-34"></use></g></svg><span></span><span><svg height="11.7782pt" style="vertical-align:-3.42938pt" version="1.1" viewbox="22.555183800000002 -8.3
{"title":"The Diagnostic Evaluation of the SINEH Cardiopulmonary Triage Scale and the Emergency Severity Index in the Emergency Department: A Comparative Study","authors":"Mahbobeh VatanKhah, Javad Malekzadeh, Mohammad-Davood Sharifi, Amir Mirhaghi","doi":"10.1155/2024/3018777","DOIUrl":"https://doi.org/10.1155/2024/3018777","url":null,"abstract":"<i>Introduction</i>. The diagnostic evaluation of the emergency severity index (ESI) in the triage of patients with cardiopulmonary complaints has a high sensitivity but a low specificity in the emergency department (ED). Therefore, triage scales with more accurate diagnostic evaluation are required. As a result, accuracy of the SINEH triage scale (SinTS) and the ESI was compared to compare mistriage of critically ill patients with cardiopulmonary complaints. <i>Methods</i>. This descriptive, analytical and cross-sectional study was conducted between December 2022 and April 2023. In this study, two nurses independently examined each patient using two triage scales. The admission unit and length of hospital stay were also recorded. The outcome was classified as high-risk admission (cardiac care unit and intensive care unit) and low-risk admission (internal unit or discharge from the ED). Undertriage and overtiage were defined as high-risk admission with triage level 3 and 4 and low-risk admission with triage level 1 or 2, respectively. A panel of experts evaluated content validity of SinTS and kappa designating agreement on relevance reported. The inter-rater reliability of two scales was also reported. <i>Results</i>. Finally, the study included 145 patients. The average age of the patients studied was 61.35 years. SinTS has a total mistriage of 29.63%, with 4.13% being undertriage and 25.5% being overtriage. In ESI, the total mistriage is 66.8%, with 1.3% being undertriage and 65.5% being overtriage. The undertriage of the two scales did not differ significantly by admission unit (<span><svg height=\"11.7782pt\" style=\"vertical-align:-3.42938pt\" version=\"1.1\" viewbox=\"-0.0498162 -8.34882 18.973 11.7782\" width=\"18.973pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,11.342,0)\"></path></g></svg><span></span><span><svg height=\"11.7782pt\" style=\"vertical-align:-3.42938pt\" version=\"1.1\" viewbox=\"22.555183800000002 -8.34882 21.921 11.7782\" width=\"21.921pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,22.605,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,28.845,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,31.809,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,38.049,0)\"></path></g></svg>),</span></span> but the overtriage of the two methods did (<span><svg height=\"11.7782pt\" style=\"vertical-align:-3.42938pt\" version=\"1.1\" viewbox=\"-0.0498162 -8.34882 18.973 11.7782\" width=\"18.973pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-113\"></use></g><g transform=\"matrix(.013,0,0,-0.013,11.342,0)\"><use xlink:href=\"#g117-34\"></use></g></svg><span></span><span><svg height=\"11.7782pt\" style=\"vertical-align:-3.42938pt\" version=\"1.1\" viewbox=\"22.555183800000002 -8.3","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"9 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140197904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. The community transmission of COVID-19 has caused the breakdown of the regional emergency medical system (REMS), impacting the rights and care of regional patients with acute and severe conditions. This study proposes a model for the surge capacity of REMS to plan for readiness and preparedness during challenging events that overload capacity. Methods. The surge capacity of REMS during the COVID-19 pandemic was studied. The data collection included 26 hospitals that received the data. To simulate the dynamics of Taipei’s REMS surge capacity, we observed its ability to treat COVID-19 patients with moderate to severe acute respiratory distress syndrome (ARDS). This will involve monitoring the stock of ventilators, physicians, and nurses within the subsystem loops. Results. Healthcare managers and administrators can use the overload model and hypothetical scenarios to develop new scenarios with different demands on surge capacity. The REMS system capacity model can be used as an aid to guide planning and cross-checking for address Prepare to plan. Conclusions. We combined data regarding the availability of ventilators, physicians, nurses, specialized beds, and general acute care beds in our simulations. Thus, our simulations, with support from a well-established regional command and management structure, could help REMS achieve the optimal surge capacity.
{"title":"Surge Capacity of Taipei’s Regional Emergency Medical System during COVID-19: A System Dynamics Approach","authors":"Chih Chang Chen, Su Ying Hung","doi":"10.1155/2024/5524382","DOIUrl":"https://doi.org/10.1155/2024/5524382","url":null,"abstract":"<i>Background</i>. The community transmission of COVID-19 has caused the breakdown of the regional emergency medical system (REMS), impacting the rights and care of regional patients with acute and severe conditions. This study proposes a model for the surge capacity of REMS to plan for readiness and preparedness during challenging events that overload capacity. <i>Methods</i>. The surge capacity of REMS during the COVID-19 pandemic was studied. The data collection included 26 hospitals that received the data. To simulate the dynamics of Taipei’s REMS surge capacity, we observed its ability to treat COVID-19 patients with moderate to severe acute respiratory distress syndrome (ARDS). This will involve monitoring the stock of ventilators, physicians, and nurses within the subsystem loops. <i>Results</i>. Healthcare managers and administrators can use the overload model and hypothetical scenarios to develop new scenarios with different demands on surge capacity. The REMS system capacity model can be used as an aid to guide planning and cross-checking for address Prepare to plan. <i>Conclusions</i>. We combined data regarding the availability of ventilators, physicians, nurses, specialized beds, and general acute care beds in our simulations. Thus, our simulations, with support from a well-established regional command and management structure, could help REMS achieve the optimal surge capacity.","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"16 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140125570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maciej Niczewski, Szymon Gawęda, Paulina Kluszczyk, Mikołaj Rycerski, Daria Syguła, Anna Danel, Szymon Szmigiel, Konrad Mendrala, Aleksandra Oraczewska, Czarosław Kijonka, Monika Nowicka, Michał Wita, Tomasz Cyzowski, Grzegorz Brożek, Maciej Dyrbuś, Szymon Skoczyński
Objective. An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes. Methods. The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguished—arterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1–quartile 3) 2 (1–4) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated. Results. The short-term mortality was 35.2% (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO2 on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1 mmol/L increasing all-cause mortality by 58% in ABG (95% CI: 1.01–2.47), by 80% in VBG (95% CI: 1.13–2.88), and by 68% in the mixed blood gas analysis (95% CI: 1.22–2.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO2, and pCO2 did not predict short-term mortality. Conclusions. In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.
{"title":"The Predictive Role of Lactate in the Emergency Department in Patients with Severe Dyspnea","authors":"Maciej Niczewski, Szymon Gawęda, Paulina Kluszczyk, Mikołaj Rycerski, Daria Syguła, Anna Danel, Szymon Szmigiel, Konrad Mendrala, Aleksandra Oraczewska, Czarosław Kijonka, Monika Nowicka, Michał Wita, Tomasz Cyzowski, Grzegorz Brożek, Maciej Dyrbuś, Szymon Skoczyński","doi":"10.1155/2024/6624423","DOIUrl":"https://doi.org/10.1155/2024/6624423","url":null,"abstract":"<i>Objective</i>. An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes. <i>Methods</i>. The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguished—arterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1–quartile 3) 2 (1–4) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated. <i>Results</i>. The short-term mortality was 35.2% (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO<sub>2</sub> on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1 mmol/L increasing all-cause mortality by 58% in ABG (95% CI: 1.01–2.47), by 80% in VBG (95% CI: 1.13–2.88), and by 68% in the mixed blood gas analysis (95% CI: 1.22–2.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO<sub>2</sub>, and pCO<sub>2</sub> did not predict short-term mortality. <i>Conclusions</i>. In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"135 1 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140007850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yi Liu, Yunhe Gao, Zhida Chen, Jianxin Cui, Wenquan Liang, Ze Wang, Linde Sun, Chuan Pang, Yuan Lv, Guoxiao Liu, Tingting Lu, Gan Zhang, Xiaoyu Dong, Hong Xu, Sheng Yao, Feng Liang, Gang Liu, Gang Chen, Jianmiao He, Wentong Xu, Bo Wei, Hongqing Xi, Lin Chen
<i>Objective</i>. Large-scale studies on the characteristics and management of abdominal trauma in megacities in China are lacking. The aim of this study was to analyze and present the clinical patterns and treatment status of abdominal trauma in regional medical centers. <i>Methods</i>. Cases of abdominal trauma treated at seven medical centers in Beijing from 2010 to 2021 were collected. Clinical information about age, sex, injury cause, geographic distribution, abbreviated injury scale/injury severity score (AIS/ISS) value, injury-hospital time, preoperative time, surgically identified organ injuries, type of surgery, causes of reoperation and 90-day mortality was included in this study. Clinical characteristics, treatment methods, and short-term prognoses (90-days survival) were compared between blunt abdominal trauma (BAT) and penetrating abdominal trauma (PAT) cases. Non-normally distributed data are described as medians (IQR), and the Mann‒Whitney <i>U</i> test was performed; qualitative data were analyzed using the <svg height="11.6412pt" style="vertical-align:-0.04979992pt" version="1.1" viewbox="-0.0498162 -11.5914 15.0284 11.6412" width="15.0284pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"></path></g><g transform="matrix(.0091,0,0,-0.0091,9.945,-5.741)"></path></g></svg> test. Univariate and multivariate survival analyses were performed by the Cox proportional hazards model. <i>Results</i>. A total of 553 patients (86.98% male) with a median age of 36.50 (27.00–48.00) years were included. The BAT group had a significantly higher proportion of serious injury (<span><svg height="8.8423pt" style="vertical-align:-0.2064009pt" version="1.1" viewbox="-0.0498162 -8.6359 19.289 8.8423" width="19.289pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"></path></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"></path></g></svg><span></span><span><svg height="8.8423pt" style="vertical-align:-0.2064009pt" version="1.1" viewbox="22.8711838 -8.6359 28.182 8.8423" width="28.182pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,22.921,0)"></path></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"></path></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><use xlink:href="#g113-49"></use></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-49"></use></g><g transform="matrix(.013,0,0,-0.013,44.605,0)"></path></g></svg>),</span></span> lower initial hemoglobin level (<span><svg height="8.8423pt" style="vertical-align:-0.2064009pt" version="1.1" viewbox="-0.0498162 -8.6359 19.289 8.8423" width="19.289pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"></use></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:h
目的。中国特大城市腹部创伤的特点和处理缺乏大规模研究。本研究旨在分析和介绍区域医疗中心腹部创伤的临床模式和治疗状况。方法。收集 2010 年至 2021 年北京 7 家医疗中心收治的腹部创伤病例。研究包括年龄、性别、受伤原因、地理分布、缩写损伤量表/损伤严重程度评分（AIS/ISS）值、受伤住院时间、术前时间、手术确定的器官损伤、手术类型、再次手术原因和 90 天死亡率等临床信息。比较了钝性腹部创伤（BAT）和穿透性腹部创伤（PAT）病例的临床特征、治疗方法和短期预后（90 天存活率）。非正态分布数据以中位数（IQR）表示，并进行曼-惠特尼 U 检验；定性数据采用该检验进行分析。采用 Cox 比例危险度模型进行单变量和多变量生存分析。结果共纳入 553 名患者（86.98% 为男性），中位年龄为 36.50（27.00-48.00）岁。与 PAT 组相比，BAT 组的严重损伤比例明显更高（），初始血红蛋白水平更低（1），腹腔镜手术率更低（）。此外，更多的 BAT 病例来自北京周边地区（），受伤后的区域住院时间更长（10.47（5.18-22.51）小时对 7.00（3.80-15.38）小时）。在空腔脏器损伤亚组中，与 PAT 组相比，BAT 组的损伤-区域住院时间和术前时间明显更长（损伤-区域住院时间：10.23 (6.00-21.59) 小时 vs. 7.07 (3.99-13.85) 小时；术前时间：3.02 (2.01-5.01) 小时 vs. 7.00 (3.80-15.38) 小时）：术前时间：3.02（2.01-5.58）小时 vs. 2.81（1.85-3.63）小时）。90天的总死亡率为11.9%，较长的受伤区域住院时间（HR：1.01，95% CI：1.00-1.02，）、接受重症监护室治疗（HR：4.69，95% CI：2.54-8.65，）和严重的ISS（ISS > 25 vs. ISS < 16，HR：2.78，95% CI：1.38-5.601，）对存活率的影响更大。结论是更多的 BAT 患者被转到更高级别的医院，导致院前和术前时间明显延长。在血流动力学稳定的亚组中，更多的 BAT 患者出现空腔脏器损伤。对这些患者来说，积极的腹腔镜诊断性探查可能是有益的。损伤与区域住院时间间隔较长、需要重症监护室护理和损伤严重程度评分（ISS）较高的患者预后较差。
{"title":"Comparison of Clinical Characteristics, Therapy, and Short-Term Prognosis between Blunt and Penetrating Abdominal Trauma: A Multicentric Retrospective Cohort Study","authors":"Yi Liu, Yunhe Gao, Zhida Chen, Jianxin Cui, Wenquan Liang, Ze Wang, Linde Sun, Chuan Pang, Yuan Lv, Guoxiao Liu, Tingting Lu, Gan Zhang, Xiaoyu Dong, Hong Xu, Sheng Yao, Feng Liang, Gang Liu, Gang Chen, Jianmiao He, Wentong Xu, Bo Wei, Hongqing Xi, Lin Chen","doi":"10.1155/2024/5215977","DOIUrl":"https://doi.org/10.1155/2024/5215977","url":null,"abstract":"<i>Objective</i>. Large-scale studies on the characteristics and management of abdominal trauma in megacities in China are lacking. The aim of this study was to analyze and present the clinical patterns and treatment status of abdominal trauma in regional medical centers. <i>Methods</i>. Cases of abdominal trauma treated at seven medical centers in Beijing from 2010 to 2021 were collected. Clinical information about age, sex, injury cause, geographic distribution, abbreviated injury scale/injury severity score (AIS/ISS) value, injury-hospital time, preoperative time, surgically identified organ injuries, type of surgery, causes of reoperation and 90-day mortality was included in this study. Clinical characteristics, treatment methods, and short-term prognoses (90-days survival) were compared between blunt abdominal trauma (BAT) and penetrating abdominal trauma (PAT) cases. Non-normally distributed data are described as medians (IQR), and the Mann‒Whitney <i>U</i> test was performed; qualitative data were analyzed using the <svg height=\"11.6412pt\" style=\"vertical-align:-0.04979992pt\" version=\"1.1\" viewbox=\"-0.0498162 -11.5914 15.0284 11.6412\" width=\"15.0284pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"></path></g><g transform=\"matrix(.0091,0,0,-0.0091,9.945,-5.741)\"></path></g></svg> test. Univariate and multivariate survival analyses were performed by the Cox proportional hazards model. <i>Results</i>. A total of 553 patients (86.98% male) with a median age of 36.50 (27.00–48.00) years were included. The BAT group had a significantly higher proportion of serious injury (<span><svg height=\"8.8423pt\" style=\"vertical-align:-0.2064009pt\" version=\"1.1\" viewbox=\"-0.0498162 -8.6359 19.289 8.8423\" width=\"19.289pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,11.658,0)\"></path></g></svg><span></span><span><svg height=\"8.8423pt\" style=\"vertical-align:-0.2064009pt\" version=\"1.1\" viewbox=\"22.8711838 -8.6359 28.182 8.8423\" width=\"28.182pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,22.921,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,29.161,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,32.125,0)\"><use xlink:href=\"#g113-49\"></use></g><g transform=\"matrix(.013,0,0,-0.013,38.365,0)\"><use xlink:href=\"#g113-49\"></use></g><g transform=\"matrix(.013,0,0,-0.013,44.605,0)\"></path></g></svg>),</span></span> lower initial hemoglobin level (<span><svg height=\"8.8423pt\" style=\"vertical-align:-0.2064009pt\" version=\"1.1\" viewbox=\"-0.0498162 -8.6359 19.289 8.8423\" width=\"19.289pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-81\"></use></g><g transform=\"matrix(.013,0,0,-0.013,11.658,0)\"><use xlink:h","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"29 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139762925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tim Baker, Claudio Gatti, Guido Rossini, Habtamu Tolla, Anne Detjen, Mulugeta Mideksa, Nadeen Hilal, Rima Shaya
The COVID-19 pandemic led to a surge of critically ill patients and a sudden increase in the need for oxygen treatment worldwide. Pre-existing gaps in oxygen systems became apparent, and governments, multilateral agencies, and other partners scrambled to increase the production, supply, and use of oxygen to meet this need. The importance of an oxygen ecosystem that is appropriate for the local context became clear. This review describes strategies for oxygen ecosystems in middle-income countries, with specific experiences from Lebanon, following the authors’ extensive assessment of the country’s oxygen ecosystem, on behalf of the government and UNICEF. In the assessment, fifteen governmental hospitals were visited and evaluated using the UNICEF Oxygen System Planning Tool, discussions were held with key stakeholders, and documents were reviewed. An optimal oxygen ecosystem needs to take into consideration the production of oxygen and delivery to facilities, the maintenance system within facilities, and the clinical use of oxygen. Lebanon, a lower-middle income country in the Middle East, is contending with an extensive economic crisis affecting the health system. Eighteen recommendations for strengthening the oxygen ecosystem in Lebanon that are relevant for other middle-income countries include the establishment of a National Oxygen Committee, installation of additional oxygen plants, strengthened systems for maintenance and electricity supply, increased production, procurement and supply chain resilience, improved training and human resources, the use of data collection and regular information to guide the ecosystem, and integration of oxygen into the rest of the health system.
{"title":"Strategies for Oxygen Ecosystems in Middle-Income Countries: A Review and Case Study from Lebanon","authors":"Tim Baker, Claudio Gatti, Guido Rossini, Habtamu Tolla, Anne Detjen, Mulugeta Mideksa, Nadeen Hilal, Rima Shaya","doi":"10.1155/2024/9964636","DOIUrl":"https://doi.org/10.1155/2024/9964636","url":null,"abstract":"The COVID-19 pandemic led to a surge of critically ill patients and a sudden increase in the need for oxygen treatment worldwide. Pre-existing gaps in oxygen systems became apparent, and governments, multilateral agencies, and other partners scrambled to increase the production, supply, and use of oxygen to meet this need. The importance of an oxygen ecosystem that is appropriate for the local context became clear. This review describes strategies for oxygen ecosystems in middle-income countries, with specific experiences from Lebanon, following the authors’ extensive assessment of the country’s oxygen ecosystem, on behalf of the government and UNICEF. In the assessment, fifteen governmental hospitals were visited and evaluated using the UNICEF Oxygen System Planning Tool, discussions were held with key stakeholders, and documents were reviewed. An optimal oxygen ecosystem needs to take into consideration the production of oxygen and delivery to facilities, the maintenance system within facilities, and the clinical use of oxygen. Lebanon, a lower-middle income country in the Middle East, is contending with an extensive economic crisis affecting the health system. Eighteen recommendations for strengthening the oxygen ecosystem in Lebanon that are relevant for other middle-income countries include the establishment of a National Oxygen Committee, installation of additional oxygen plants, strengthened systems for maintenance and electricity supply, increased production, procurement and supply chain resilience, improved training and human resources, the use of data collection and regular information to guide the ecosystem, and integration of oxygen into the rest of the health system.","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"21 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139662780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-24eCollection Date: 2024-01-01DOI: 10.1155/2024/9820745
Emergency Medicine International
[This retracts the article DOI: 10.1155/2022/5707504.].
[本文撤回了文章 DOI：10.1155/2022/5707504.]。
{"title":"Retracted: Effect of miR-144-3p-Targeted Regulation of PTEN on Proliferation, Apoptosis, and Osteogenic Differentiation of Bone Marrow Mesenchymal Stem Cells under Stretch.","authors":"Emergency Medicine International","doi":"10.1155/2024/9820745","DOIUrl":"10.1155/2024/9820745","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.1155/2022/5707504.].</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2024 ","pages":"9820745"},"PeriodicalIF":1.2,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10830186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-24eCollection Date: 2024-01-01DOI: 10.1155/2024/9768409
Emergency Medicine International
[This retracts the article DOI: 10.1155/2023/2303766.].
[本文撤回了文章 DOI：10.1155/2023/2303766.]。
{"title":"Retracted: Value of Humanized Nursing under Emergency Green Channel on Gastrointestinal Function Recovery in Patients with Acute Intestinal Obstruction after Operation.","authors":"Emergency Medicine International","doi":"10.1155/2024/9768409","DOIUrl":"10.1155/2024/9768409","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.1155/2023/2303766.].</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2024 ","pages":"9768409"},"PeriodicalIF":1.2,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10830266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives. Popliteal and infrapopliteal artery injuries have significant morbidity and mortality rates, especially in terms of amputation. In our study, we aimed to evaluate patients who operated due to popliteal and infrapopliteal vascular injuries in our clinic. Patients and Methods. Between 2016 and 2023; 21 patients who were operated in our clinic due to popliteal and infrapopliteal artery injuries were retrospectively evaluated. Results. 2 of the patients were female (9.5%) and 19 were male (90.5%). Age ranges were 21–78. The causes of injury were gunshot wounds in 9 patients (42.86%), blunt trauma in 7 patients (33.33%), and sharp object injuries in 5 patients (23.80%). Reversed saphenous vein interposition in 7 patients (33.33%), primary repair in 6 patients (28.57%), 6 mm polytetrafluoroethylene graft (PTFE) interposition in 3 patients (14.28%), end-to-end anastomosis in 2 patients (9.52%), saphenous-PTFE composite graft interposition in 2 patients (9.52%), and embolectomy in 1 patient (4.76%) were performed. Arterial ligation was not performed. Simultaneous orthopedic intervention was performed in 8 patients. Fasciotomy was performed in 3 patients. Venous repair was performed in 5 patients with venous injuries. Vein ligation was not performed. Mortality was observed postoperatively in 1 patient. No patient developed amputation. Foot drop developed with nerve damage in 2 patients. Conclusion. Mortality and morbidity rates may increase in popliteal and infrapopliteal artery injuries in cases of hemodynamic disorder, simultaneous bone fracture, multivessel injury, and nerve transection. These rates can be reduced by appropriate surgical repair and ensuring hemodynamic stability.
{"title":"Our Surgical Results in Popliteal and Infrapopliteal Artery Injuries: 21 Cases without Amputation","authors":"Burak Tamteki̇n, Güler Gülsen Ersoy","doi":"10.1155/2024/1721047","DOIUrl":"https://doi.org/10.1155/2024/1721047","url":null,"abstract":"<i>Objectives</i>. Popliteal and infrapopliteal artery injuries have significant morbidity and mortality rates, especially in terms of amputation. In our study, we aimed to evaluate patients who operated due to popliteal and infrapopliteal vascular injuries in our clinic. <i>Patients and Methods</i>. Between 2016 and 2023; 21 patients who were operated in our clinic due to popliteal and infrapopliteal artery injuries were retrospectively evaluated. <i>Results</i>. 2 of the patients were female (9.5%) and 19 were male (90.5%). Age ranges were 21–78. The causes of injury were gunshot wounds in 9 patients (42.86%), blunt trauma in 7 patients (33.33%), and sharp object injuries in 5 patients (23.80%). Reversed saphenous vein interposition in 7 patients (33.33%), primary repair in 6 patients (28.57%), 6 mm polytetrafluoroethylene graft (PTFE) interposition in 3 patients (14.28%), end-to-end anastomosis in 2 patients (9.52%), saphenous-PTFE composite graft interposition in 2 patients (9.52%), and embolectomy in 1 patient (4.76%) were performed. Arterial ligation was not performed. Simultaneous orthopedic intervention was performed in 8 patients. Fasciotomy was performed in 3 patients. Venous repair was performed in 5 patients with venous injuries. Vein ligation was not performed. Mortality was observed postoperatively in 1 patient. No patient developed amputation. Foot drop developed with nerve damage in 2 patients. <i>Conclusion</i>. Mortality and morbidity rates may increase in popliteal and infrapopliteal artery injuries in cases of hemodynamic disorder, simultaneous bone fracture, multivessel injury, and nerve transection. These rates can be reduced by appropriate surgical repair and ensuring hemodynamic stability.","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"59 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139552884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Petr Grenar, Jiří Nový, Karel Mědílek, Martin Jakl
Point-of-care ultrasound examinations performed by physicians of different specialties are a rapidly growing phenomenon, which has led to a worldwide effort to create a standardised approach to ultrasound examination training. The implementation of emergency echocardiography by noncardiologists is mainly aimed at the standardisation of the procedure, a structured training system, and an agreement on competencies. This article summarises the current training programmes for nonechocardiographers at the University Hospital in Hradec Králové. In cooperation with cardiologists specialised in cardiac ultrasound (ECHO), an extended acute echo protocol dedicated to emergency department physicians was developed and validated in daily practice. According to our retrospective evaluation, after one year of clinical practice, we can confirm that point-of-care ultrasound examinations performed using the standardised limited echo protocol are safe and accurate. The observed concordance with comprehensive ECHO was 78%. This trial is registered with NCT05306730.
{"title":"Point-of-Care Cardiac Ultrasound Training Programme: Experience from the University Hospital Hradec Králové","authors":"Petr Grenar, Jiří Nový, Karel Mědílek, Martin Jakl","doi":"10.1155/2024/9974284","DOIUrl":"https://doi.org/10.1155/2024/9974284","url":null,"abstract":"Point-of-care ultrasound examinations performed by physicians of different specialties are a rapidly growing phenomenon, which has led to a worldwide effort to create a standardised approach to ultrasound examination training. The implementation of emergency echocardiography by noncardiologists is mainly aimed at the standardisation of the procedure, a structured training system, and an agreement on competencies. This article summarises the current training programmes for nonechocardiographers at the University Hospital in Hradec Králové. In cooperation with cardiologists specialised in cardiac ultrasound (ECHO), an extended acute echo protocol dedicated to emergency department physicians was developed and validated in daily practice. According to our retrospective evaluation, after one year of clinical practice, we can confirm that point-of-care ultrasound examinations performed using the standardised limited echo protocol are safe and accurate. The observed concordance with comprehensive ECHO was 78%. This trial is registered with NCT05306730.","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"80 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139374324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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