Emergency Medicine Journal最新文献

Background: Civilians in South Africa experience a high incidence of crush injury, or traumatic rhabdomyolysis. Community assault (CA) is a common mechanism of crush injury in South Africa, where victims are assaulted by multiple persons using a variety of objects. A crush injury places patients at risk of renal dysfunction. The study objective is to evaluate the association between CA and adverse renal outcomes (AROs) among patients with crush injury.

Methods: In this secondary analysis of abstracted medical records, we examined clinical data from adult crush patients who presented to one of six trauma centres in the Western Cape Province of South Africa from September 2021 to December 2023. ARO was defined as potassium >6 mEq/L, creatinine >4 mg/dL, initiation of dialysis or death due to renal failure. We used multivariable logistic regression to evaluate the association between CA and ARO.

Results: Of 976 crush patients (mean age 32 years, 89% male), half were victims of CA (n=464, 48%). 4% of the overall cohort had ARO, but less than 1% (n=7) received dialysis. More patients with CA developed ARO (n=27, 6%) compared with patients without CA (n=15, 3%) (unadjusted p=0.03). In-hospital all-cause mortality was not significantly different between CA and non-CA (8% vs 7%, p=0.58). After adjusting for age, sex, systolic blood pressure and injury severity, patients with CA had 2.42 times the odds of ARO than patients without CA (95% CI 1.20 to 4.85, p=0.01).

Conclusion: This study suggests that CA is an independent risk factor for AROs among patients with crush injury in South Africa. Victims of CA with renal dysfunction require aggressive resuscitation and may warrant early transfer to tertiary care centres.

Introduction: The emergency medical disease burden in low-income countries such as Ethiopia is four times that of high-income countries. It is estimated that more than half of all deaths occurring in low-and-middle-income countries each year could be prevented by organised Emergency Care System but the emergency care in these countries is fragmented and unstructured. The WHO's Emergency Care Systems (WHO-ECS) toolkit aims to systematise and structure emergency care in such countries. Objectives To identify and analyse key facilitators and barriers encountered during the implementation of the (WHO-ECS) toolkit in primary hospitals in Ethiopia, within the context of a national emergency care strengthening initiative.

Methods: This was a qualitative research arm of a larger implementation study conducted within 10 primary hospitals in the Oromia region, Ethiopia for 14 months. Qualitative data were collected using focus group discussions with healthcare workers in target hospitals (Amaya, Arsi Kersa, Tulu Bolo and Robe Dida Hospitals) selected via lottery method and key-informant questionnaires among project coordinators from May 2021 to February 2022. Facilitators and barriers to the implementation process were identified using thematic data analysis.

Results: There were 40 participants in four focus group discussions and four respondents to the key informant questionnaires. Facilitators of the toolkit included a supportive model of implementation, enthusiastic staff and the toolkit itself. Lack of medications and equipment, some components in the toolkit itself and lack of permanent staff in emergency departments were found to be barriers. Support from hospital administrators was a facilitator while lack thereof was a hurdle.

Conclusion: This study has outlined the significant factors related to implementing the WHO-ECS toolkit in a low-income setting. Support from project implementers and hospital administrators as well as key stakeholder involvement facilitates success. Conversely, lack of support and resources as well as toolkits misaligned with context can hamper it. Comparable healthcare setups can use these lessons before and during implementation.

Objectives: The main aim of the study was (1) to assess digital literacy among acutely admitted patients in an ED, (2) to provide quantitative data relating to the 'inverse information law'. We hypothesised that a large proportion of acutely admitted patients are digitally incapable, and there is a link between age, frailty, hospital admittances and digital incapability.

Design: This study is a single-centre, cross-sectional, prospective case-controlled questionnaire study. Clinical Frailty Scale (CFS), gender and age were collected from the patients' electronic medical reports. Information regarding smartphone usage, ability to access public mail/communication, educational level, living situation and number of admittances the last year were patient-reported bedside. Subsequently, ability to use a digital platform was tested.

Setting: A secondary care ED in Denmark, with a high level of broadband penetration, allows easy digital access.

Participants: A total of 588 patients were assessed for eligibility, hereof 468 patients were included. Inclusion criteria were age above 18 years, admitted for treatment of an internal medicine or surgical problem, triaged non-emergent in a stable condition, informed oral and written consent.

Main outcome measures: The proportions of acutely admitted patients who were digitally capable versus incapable whether there is a link between age, frailty, hospital admittances and digital incapability.

Results: Among patients included, 57% (n=265) had high digital literacy, while 43% (n=203) had low literacy Δ%=14. The high digital capability group was significantly younger by 23% (15.3, 20.5) p<0.001 and had lower CFS than the low digital capability group 2.3 versus 4.2 (1.7, 2.3) p<0.001. The low digital capability group had 1.6-fold more admittances the previous year (0.5, 1.2) p<0.001.

Conclusions: The proportion of digitally illiterate patients is high (43%), and they are older, frailer and have more hospital admittances and less high education than digitally literate patients. There is a significant digital divide that needs to be considered in health care.

Background: In rural settings, women with ST-elevation myocardial infarction (STEMI) are less likely to receive timely reperfusion than men. We explore factors that may impact time to reperfusion by sex for patients with STEMI.

Methods: We conducted a cohort study of adults with STEMI activations from 2016 to 2020 using regional North Carolina STEMI registry data, which included eight rural emergency medical services (EMS) agencies and three percutaneous coronary intervention (PCI) centres. The primary outcome was EMS first medical contact to PCI in ≤90 min. By sex, we evaluated prehospital time intervals (dispatch, response, time-to-ECG, catheterisation laboratory activation, on-scene, transport and total EMS) and door-to-balloon time with clustered Wilcoxon rank-sum tests. We also evaluated agency and patient factors associated with timely reperfusion using generalised estimating equations.

Results: Of the 365 patients included, 30.1% (110/365) were female with a mean age of 62.5±12.7. Fewer women received PCI within 90 min compared with men (43.6% vs 67.8%, p<0.001). Women also experienced significantly longer total EMS time (42.5 vs 40.0 min, p=0.049) and door-to-balloon time (48.5 vs 40.0 min, p=0.01). Other time intervals were similar. After adjustment, women without exertional symptoms, with diabetes or with hypercholesterolaemia had lower odds of timely reperfusion. Among men, lower odds of timely reperfusion were observed among those without pain, who had catheterisation lab activation between 17:00 and 07:00, who were older or who had farther transport.

Conclusion: In rural settings, women without exertional chest pain and those with comorbid conditions were less likely to have timely reperfusion. Women experienced significantly longer total EMS time and door-to-balloon time than men.

Management of out-of-hospital cardiac arrest (OHCA) in a pregnant patient is challenging, both logistically and emotionally. This review explores the adaptations to resuscitation in pregnancy; the indications and preparation for prehospital resuscitative hysterotomy (RH); the surgical procedure; and the post-procedure care. Prehospital clinicians should train for RH in their teams to maximise the chances of maternal and fetal survival. Further research is needed to understand the incidence of maternal OHCA, how we can improve the chain of survival and the duration of maternal cardiac arrest before RH becomes futile to inform future guidelines.