Emergency Medicine International最新文献

Objective: This meta-analysis systematically evaluated the impact of bystander cardiopulmonary resuscitation (BCPR) on the survival of patients with out-of-hospital cardiac arrest (OHCA) and related factors. Methods: A computerized search of China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), PubMed, and Embase was conducted from the database's inception to May 1, 2023. The study included observational studies of patients who experienced OHCA and were successfully resuscitated using BCPR, following the predetermined criteria for inclusion and exclusion. The quality of the included studies was assessed using the Newcastle-Ottawa scale, with odds ratios (ORs) and 95% confidence intervals (95%CI) used as effect size measures. The data were statistically analyzed using Review Manager 5.4 software. Results: Fourteen observational studies were included in this study, involving 253,247 cases of OHCA. The primary outcome measure was survival to discharge or survival at 30 days. A meta-analysis was conducted to analyze the data from these 14 studies. The findings indicated that the no-BCPR group had a significantly reduced survival rate compared to the BCPR group (OR: 1.72, 95% CI: 1.40-2.12, p < 0.05). Secondly, the study examined 14 studies that focused on prehospital return of spontaneous circulation and neurological recovery before they reached the hospital. The findings revealed that patients who received BCPR had a higher rate of prehospital ROSC (OR: 2.06, 95% CI: 1.66-2.57, p < 0.05) and experienced better neurological recovery (OR: 2.03, 95% CI: 1.67-2.47, p < 0.05) compared to those who did not receive BCPR. This difference was found to be statistically significant. Conclusion: BCPR can potentially enhance the likelihood of survival for patients experiencing OHCA. BCPR can offer patients an opportunity for both survival and favorable neurological recovery during the time when emergency medical services (EMS) respond. Given the existing circumstances, it is advisable to enhance the promotion and training of public CPR and improve the prevalence of bystander CPR in society since this is expected to yield substantial social advantages.

Background: The management of contaminated airways potentially compromises the quality of cardiopulmonary resuscitation (CPR). Objectives: This study examined the effect of suction-assisted laryngoscopy airway decontamination (SALAD) compared to intermittent suction in maintaining CPR quality during intubation in a simulated scenario of regurgitation. Methods: This randomized controlled manikin simulation study employed a manikin to simulate the regurgitation of gastric contents into the oropharynx during CPR. A total of 36 emergency medical technician-paramedics participated in this study. Following a 2.5 h training on the SALAD technique, all participants were randomly assigned to use either the SALAD technique (n = 18) or intermittent suction (n = 18) during intubation on the manikin. The primary outcomes were CPR quality metrics, including chest compression rate, depth, and interruption time. The secondary outcomes were intubation success rate, intubation time, and glottic visualization during intubation. Results: The SALAD group demonstrated significantly higher chest compression rates compared to the intermittent suction group, both before (115.7 vs. 110.9 bpm, p < 0.01) and during intubation (112.9 vs. 108.4 bpm, p < 0.05). The proportion of compression depths ≥ 5 cm was higher in the SALAD group than in the intermittent suction group, both at preintubation (61.6% vs. 44.4%) and intubation periods (55.6% vs. 27.8%). However, these differences were not statistically significant. No significant difference was observed between the two groups regarding compression depths and interruption times. A significant decrease of 2.8 bpm was observed in the compression rate of the SALAD group during intubation compared to the preintubation period (p < 0.01). In the intermittent suction group, both compression rates and depths exhibited a significant reduction during intubation (both p < 0.01) compared to the preintubation period. Intubation first-pass success rate and intubation time were comparable between the two groups. While the best glottic visualization prior to intubation was comparable between the groups, during intubation, the SALAD group demonstrated a significantly higher proportion of complete glottic visibility compared to the intermittent suction group (72.2% vs. 22.2%, p < 0.01). Conclusions: The SALAD technique achieved higher chest compression rates and provided better glottic visualization compared to intermittent suction during intubation in contaminated airways.

Objective: Electrical injuries present a diagnostic and management challenge due to their diverse clinical manifestations and potential complications. Although the current guidelines recommend cardiac monitoring in selected cases, the criteria for risk stratification remain limited. This study aimed to evaluate the epidemiological and clinical characteristics of patients with electrical injuries admitted to the emergency department over a 10-year period. Methods: This retrospective study reviewed medical records of patients admitted to the Pamukkale University Hospital between 2014 and 2024 due to electrical injuries. Data collected included age, sex, time of injury, voltage level, current type and source, contact site, transthoracic current pathway, ECG findings, laboratory results (troponin T, CK-MB, and potassium), work-related status, and mortality. The primary outcomes were epidemiological characteristics, ECG abnormalities, and laboratory evidence of myocardial injury. Results: A total of 112 patients were identified; 91 (81%) patients were male, with a mean age of 31.8 years. High-voltage injuries (> 1000 V) occurred in 10 patients, while low-voltage injuries (< 1000 V) were seen in 80 (60.6%) patients. Work-related injuries accounted for 14.3% of cases. One patient died due to trauma following high-voltage exposure. Troponin T was elevated in 57 of 92 tested patients (62.0%), CK-MB in 25 (22.3%), and hyperkalemia in six (5.3%). ECG abnormalities were detected in 16 patients (14.3%). Conclusion: Biochemical evidence of myocardial injury was observed even in low-voltage exposures, raising concerns about the safety of early discharge based solely on clinical presentation and ECG findings. Prospective studies are needed to refine risk assessment strategies in electrical injury cases.

Background: Cattle-related trauma is common in rural areas and is a significant cause of morbidity and mortality, often requiring hospital admission and surgical treatment. However, no literature is currently available on cattle-related trauma in China. We reviewed all patients with cattle-related trauma admitted to a trauma center in China over 6 years and aimed to explore the injury characteristics and outcomes of this trauma. Methods: A retrospective cohort study was conducted, and patients with cattle-related trauma admitted from October 1, 2016, to September 31, 2022, were screened in the Hospital Information System. Demographic data, injury data, clinical treatment information, and outcomes were collected from the medical records and analyzed. Results: A total of 243 patients, with a median age of 48 years (interquartile range [IQR] 31-57), were identified. Of these, 67.5% (n = 164) were male and 88.1% (n = 214) were farmers. Traveling in a bullock cart as a passenger (31.7%, n = 77) was the most frequent injury situation, and bullock cart accident (57.6%, n = 140) was the most common injury mechanism. Blunt trauma occurred in most patients (86.4%, n = 210). The most commonly injured body region was the lower extremity, pelvis and buttocks (38.3%, n = 93). Among the patients, 111 (45.7%) had at least one abbreviated injury scale (AIS) of ≥ 3. Overall, the median injury severity score (ISS) was 8 (IQR 4-13), and 39 patients (16.0%) had an ISS ≥ 16. In total, 209 patients (86.0%) underwent surgical treatment, and 69 (28.4%) were admitted to the intensive care unit (ICU). The median length of hospital stay (LOS) was 10 days (IQR 6-18), and the mortality rate was 1.2% (n = 3). Conclusions: This study demonstrated the characteristics of cattle-related trauma in a trauma center in China. Our results may contribute to the development of data-driven safety measures to reduce the risk of cattle-related trauma.

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.